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APPLICATION FOR ADVISORY GROUPS _ <br /> Group Applied For: <br /> Eu 6'IR' ONmt,+thl QUA1/ % F1Si! fop« <br /> Second Choice ( if any) : <br /> Full Name (print or type) : <br /> , ckk►R' L Ommi <br /> Address : <br /> BIOS 6ROV6IsA,03 i?o f137 rr)tV)✓aS V5CW <br /> ,years At This Address : Years You Have Lived In Mounds View: <br /> Telephone: Home: <br /> Work or Other: : <br /> 269 <br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br /> Skills and Interests : <br /> Employment, Occupation or Other Experience: <br /> ,QF m a deAv.5 Cc,v7R ArTO,e - 00,v-17-R1-'74'v 7"04' , <br /> Memberships, Accomplishments Or Other Qualifications: <br /> nlA,'.J, 655 <br /> D Ejg'( - Me, eon,�,v,� >`/ Oc i/6:56 - <br /> Please State Your Reasons For Wanting To Serve On This Committee: <br /> per50nv/7i Tiv reA"ES l .13e:ii,PF ro /h'�PRC ve oc ilei T E'j,+4s <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 C� ra ,y, Date 7--„) 9% <br /> The City 6 Mounds Viewiscommitted 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 />