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f <br /> APPLICATION FOR ADVISORY GROUPS . <br /> Group Applied For: <br /> E,v 1RcN mf,✓r,9t C v 11);7 ' 7,75Jf JZ,g <br /> Second Choice ( if any) : <br /> Full Name (print or type) : <br /> �IeJARo2 D. O1/2799,1/ <br /> Address : <br /> has G�,,�i��sucl Ro/Pa7 fi n v 1tX s I/;r;A1 <br /> Years At This Address : Years You Have Lived In Mounds View: <br /> I I <br /> Telephone: Home: Work or Other: . <br /> 7(FG-6G79 786-6 709 <br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br /> • <br /> Skills and Interests : <br /> Employment, Occupation or Other. Experience: <br /> .QFin4dth;3 eo,v,-,,FxTc.Q — -RI)O C'o,s4TAvc71O•v CO-. <br /> Memberships, Accomplishments Or Other Qualifications : <br /> r/ AR.S/ 655 <br /> g A D eye( - n0mmt)/my CJC Nei <br /> Please State Your Reasons For Wanting To Serve On This Committee: <br /> �F�,1oN,gL SivreeES:J 4r=1/41'e TO /mPRc✓F de A. ;At <br /> Your response to any of the above may be continued on the back . <br /> and you may attach any other materials_ which you want the Council <br /> to consider. <br /> Signature , , 2 (2 - Date 7-,,)D— <br /> The City of Mounds View is committed to the policy that all <br /> • <br /> persons shall have equal access to its programs, facilities , and <br /> employment without regard to race, creed, color, sex, age, <br /> national origin, or handicap. <br />