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City of Mounds View <br />2401 Highway 10 <br />Mounds View, MN 55112 <br />(763)717-4000 <br />Application for Advisory Boards and Commissions <br />Group Applied for: <br />i <br />Full Name (Please Print): //I <br />e67 <br />z c 51,6 <br />Home Phone: ff3 -�_`J Work Phone: �� �c�� S `� -71 <br />Address: Feil—rrt C bri V-efilUL�U'IC4S V l •� %�i /V �� <br />Years at this address: o /Z— <br />E-mail Address: 40 Z - <br />i/ <br />Years you have Iived in Mounds View: � ( _ <br />ualifications You Want to Have the Mayor and City Council Consider: <br />Skills and Interests: <br />L.l.,�i�� <br />plo�yfinent, Occupation or Other Experience: Gz <br />Memberships, Accomplishments or Other Qualifications: �?' e_` <br />` <br />vtz�"-,�Gc� � •��'�'- (.�C�z"� �-- GJ2�f ' G� Z'-�iL�2 �--Jti.c�.•-l� <br />Please state your reason for wanting to serve with this group: <br />Gs,'�=y� �� ���'-Z.`, G�-�-z�`Z; ✓�'� �u-c��,i � ��'��e�Z-X.� C d�i-��t2 ��y-; <br />Signature: Date: <br />(Your response to any of the above inquiries may be continued on the back of this form and you <br />may attach any other material that you would want the Mayor and Council to consider.) <br />The City of Mounds View is committed to the policy that all persons shall have access to its programs, <br />Facilities and employment without regard for race, creed, color, sex, age, national origin or handicap. <br />