Laserfiche WebLink
CITY OF MOUNDS VIEW <br /> 2401 HIGHWAY 10 <br /> MOUNDS VIEW, MN 55112 <br /> (612) 784-3055 <br /> APPLICATION FOR ADVISORY GROUPS <br /> Group Applied for: T u -7J 7.)e Na CgrApvtt 5s to IQ <br /> Second Choice (if any): <br /> Full Name (print or type): 1--A-t) (0,5' D tfyvl/q AI 1.1-4..-,5411" <br /> Phone: Home: ti FS -- lit 2 Work er-ether: <br /> Address: p-2._3 16volturub-c0 <br /> Years at this Address: <br /> Years You Have lived in Mounds View: 5 <br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER: <br /> Skills and Interests: C - -A - $ - -- ala t �. �, ,t�,,., I h4 wpIv`-t1 <br /> (PAIo I46-a.t s C cs : l-44-ru 0 U56- 1167-411,1H <br /> Employment, Occupation, or Other Experience: <br /> Memberships, Accomplishments, or Other Qualifications: <br /> Please State Your Reason for Wanting to Serve on this Committee: <br /> Your response to any of the above inquiries may be continued on the back and you <br /> may attach any other materi- which you want the City Council to consider. <br /> Signature: fi i 4(11' / <br /> Date <br /> The City of Mounds View is committed to the policy that all persons shall have equal access to its programs, <br /> facilities, and employment without regard to race, creed, color, sex, age, national origin, or handicap. <br />