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• <br /> ,item 1 <br /> 0 . • . <br /> APPLICATION FOR ADVISORY GROUPS <br /> •. <br /> Group app1i� a For). fia-k. = Ia 1e_ 4-0- c't___, , <br /> Second Choice ( if any) : <br /> Full �y_ame (print or t p , �a/22�� <br /> /1 , Dot <br /> Address ba Lr. /, , , G _4 <br /> Years xt This A•dress : Years You Have Live In Mounds View: <br /> Is- <br /> Work or Other: <br /> Telephone: Home: _ <br /> 7�'i9 -- 3 S-1 t <br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br /> Skills and In erests - , a <br /> Employment, Occupation 9F Other Experience: - <br /> ill • pet...,..t I EA!: rot.., 6_0-,),)•?_.-,,-1 4:: fav_4_,-t tAA-,..1 Ctt--rn"--rlr'--t-"--e---e-' %.1- 0:4A----1-41 111 l <br /> 77-1 -1 A)Li-W4441,-) 44-j-A1-3-'t-49-4^ t a.1,1-,t/tet-^---•-4( ( , . <br /> Memberships, Accomplishments O�� QtLA ualifications: <br /> 1.,�, y ` <br /> Please State Your Reasons For Wanting To Serve On This <br /> , Committee: <br /> p <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. ;2_7 ,� <br /> 4i �►m Date <br /> Signature "A �` <br /> The City of findS-VIe- -Is-comm-i-tted-to_the_policy <br /> that all <br /> persons shall have equal access to its programs, facilities, an <br /> employment without regard to race , creed, color, -sex, age , <br /> 1110 national origin, or handicap. <br />