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Movnms viEw <br />ADVISORY BOARD/COMMITTEE/COMMISSION APPLICATION <br />2401 Mounds View Boulevard * Mounds View MN 55112-1499 <br />(763) 717-4000 * Fax (763) 717-4019 <br />ink@moundsviewmn.org I www.moundsviewmn.org <br />* First Name MI - Last Na <br />Cer,4 IJ <br />Address <br />% 7so <br />City� � State Zip Code <br />/iM <br />Phone 1 Phone 2 Years at this Address Years in Mounds View <br />Ex. (123) 456-7890 Ex, (123)456- 6�0 <br />* Email <br />valid email roquirad( `jy f <br />Commission/Committee Applying For: <br />❑ Economic Development Commission (meets 3rd Thursday at 7:30 AM)) <br />❑ Planning Commission (meets 1st and 3rd Wednesday at 7:00 PM) <br />&Parks, Recreation $ Forestry Commission (meets 4th Thursday at 7:00 PM) <br />❑ Police Advisory Commission (meets on an "as needed" basis) <br />❑ Comprehensive Plan Task Force (meeting dates to be determined) <br />If applying for Economic Development Commission, check one box below: <br />❑ EDC - Resident Representative <br />❑ EDC - Business Representative <br />If applying fore more than one, please indicate your 1st, 2nd, etc. preference to serve: <br />Experience and Qualifications <br />Skills and Interes s � V <br />PU C,6 teli(l a J, 4r <br />f b ��� w ►'' u o � �'" ��� GAP �S-�u Y-�- <br />Employment, Occupations or Other Relevant Experience <br />U"�,lv r v' on ? A r Co",10. <br />1/2 <br />