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• <br /> APPLICATION FOR ADVISORY GROUPS . <br /> Group Applied or, ,t r lash /oor`C <br /> r�Kmtk �Second Choice ( if any) : <br /> Full Name (print or type) : <br /> �x ye f8 XQ Lue r <br /> Address : 333 £''rvvetar►d PJ . J'-18�xc�S y�.w f 11Av, _9Ss) <br /> Years At Thi Address : Years You Have Lived <br /> In Mounds View: . <br /> 33 <br /> Telephone: Home: 73 , 9-3$ Work or Other: <br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br /> Skills and Interests : _ _ <br /> laid e 1-/i4- ' � a v t c L o yo;/eve 1ELd c-&v-J Scl"v't�r u acM� c9 (Q-1 <br /> / <br /> Employment, Occupation or Other Experience: <br /> yi4L-rnu Y —, 1 61-10‘ -t de rcc‘ - oYAe,� <br /> Memberships, Accomplishments Or Other Qualifications: <br /> 1 6 kwyvt-A-A44 a ell tv'-' L0-74 — Pio/17-y <br /> Please State Your Reasons For Wanting <br /> Wanting To Serve On This Committee: <br /> 2 -A GLvi£' 4 t9vu c T e c!Cv� rn y reel)J a 'G 7L re c_i�rXe� 5 '^/ Y;3,1�•E._ ,G� <br /> )3 ? ZJ Com/ <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. c 4 <br /> Signature c/ G¢--✓� ��z�✓ Date ! — — // <br /> The City of Mounds View is committed to the policy that all <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 />