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APPLICATION FOR ADVISORY GROUPS_ <br /> Group Applied For: /'1 <br /> 1 .i u11! -►�1&1A _ <br /> Second- Choice ( if any) : - <br /> Full Name (print or type) : <br /> A N, y ,rN 61 O1 <br /> Address: : <br /> 26102 O/A GWS <br /> YearsAt This Address : , - Years- You Have i ed In _Mounds.View: - <br /> MOS te; <br /> Telephone: : Home: - Wo k or Other: - . <br /> 7$6r 26i(' 5 <br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br /> Skills and Interests : <br /> my 1bWeiez whPrzoi <br /> 1 'C So\-61JA CE f 11.1616so <br /> Employment, Occupation or Other Experience: - - <br /> WO& AS U 1 NI G Mict4tet fle NWgi UtK )IJ 5r eft. <br /> la(4 .=016 byes,, n IQUC JotJ Nu (01 <br /> Memberships, Accomplishments Or Other-Qualifications:_- : <br /> MNk vNi otJ %SPE' x5y1e6 <br /> CSN.; • < r s2 105 (1144k <br /> • ease State Your Reasons For ' -nting .To Serve On This Committee: <br /> lAitt 4 V rm5_,\iefor <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 ni .. / Date <br /> -- - <br /> Trie City of-Mounds -View is- committed- to-the policy- _ hat 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 />