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q. ) 4 r <br /> Iv <br /> 14 taVea. i <br /> APPLICATION. FOR ADVISORY GROUPS Velto-EPP <br /> Group Applied For: j/f ) ! (?Urnni&S ion oo►AO f/ <br /> Second Choice ( if any) . ' <br /> Full Name (print or type) : c-1a CLL I_ i 5-1-JU61-1501 <br /> Address : g 0-1 <br /> 7 cJ -.,fan <br /> Y <br /> aarS At This . dress: Years You Have Lived Ia Mounds Views <br /> /I,/ I <br /> Telephone: H me: k. •r <br /> � - i Saco - ` - 0 -rt . �" <br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br /> Skills a d Interests :. - .'i,.m• 1,7 i^ Spec ill mC{y`�I, /` ellorit.,ofti��1 <br /> Issas. I (,n� r Cin,_ l /n`et/ , /n s' -tS n�G c� <br /> CSC 1�, d`2.�rCt �zcZ� Cyr) Vizir •- if C' <br /> � � ns . <br /> Em loyment,, ccupation or blither Experience: <br /> 66-5, uS m-e S.:S cAd rr, is r t <br /> a.1-{ 9 i )I t)/( ct L S ( L l uCtz Q t <br /> S <br /> Memberships, Accomplishments Or Ot er Qualiiica ions: <br /> CLUITOlt-LeCtAk, Y AQC, CeNi-vu. Air 1 i , ) <br /> --Parnme_ ''co lec-:),-6 )6{pttkii--A ceigcL,n <br /> -/-1Leh,Qi- Tc-ircdx.— rn('L-C-uf ' <br /> Please State Your Reasons For WantingToServe On This: Committee: <br /> ► '.A1.'. a tS R ,' L ' I Al - Al ' <br /> r <br /> iv, �'31C(lr1 r14• C.ta ( Q' ,) "• 0 . vi...t7 <br />- - b'ia �1eiC / <br /> j rn ln�{f�L, '. 1/1 U)1 L <br /> Your response to any of the above may be co inued on the back <br /> and you may attach any other materials which you want the Council <br /> to consider. <br /> Signature .% Date 4, - 1-1--- cif <br /> 6, <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 />