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III APPLICATION FOR ADVISORY GROUPS <br /> Group Applied For: —Pa' 1 <br /> .1�oaI� (~J <br /> Second Choice ( if any) : <br /> Full Name (print or type) :„.er tee S+e rerSOr' <br /> Address: any- IS - � <br /> man s4-�., N p <br /> Years At This Address : Years You Have Lived In Mounds View: <br /> v - c-tR- • I / gear' <br /> Telephone: Home: Work or ther: <br /> -7R'1I- `733 (0 —Z% - 638 <br /> QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br /> Skills and Interests : /',,, '01,6 151 . . , ' O qG 4_, C'JI;_L <br /> �- '7°f-tO. I hcuirt. par{a •Me• in G4C ad vo!/ b a yrenn is . <br /> ch !d rom h In 5tz.U . f j°',a- Deu <br /> ager ports recr en prosCi rim <br /> ployment, Occupation or Other E% p:Jrience: <br /> fpr- 5�r� <br /> floods Sctie's r6pretltc U <br /> 111 <br /> Memberships, Accomplishmen s Q Other Qualifications : <br /> ��1 ,fie Cep h—.��`' al <br /> l'Ob 000_ U <br /> Please State Your Reasons For Wanting To Serve On This Committee: <br /> >p <br /> I WI cc e 6 a • .) ���CuNu m u,e-w, tAtA � e ALl - ins . <br /> Your response to anyof the above maybe continued on the back <br /> P <br /> and you may attach any other materials which you want the Council <br /> to consider. • <br /> i <br /> Signature ....X)14- ,,� ti"yn. Date 3 -Z5 -PP <br /> The City of Mounds iew 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 /> • <br />