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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 />Full Name (Please Print): <br />Home Phone: <br />Address: <br />Years at this address: <br />E-mail Address: <br />Work Phone: <br />Years you have lived in Mounds View: <br />Qualifications You Want to Have the Mayor and City Council Consider: <br />Skills and Interests: <br />Employment, Occupation or Other Experience: <br />Memberships, Accomplishments or Other Qualifications: <br />Please state your reason for wanting to serve with this group: <br />Signature: <br />Date: <br />(Your response to any of the above inquiries may be continued ori the back of this forrii 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 />