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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: �P'r k s C_ e� � o G tl vt , i S si a <br />Full Name (Please Print): �e A, <br />Home Phone: _263 - %23- '� S6 / ._— Work Phone: __? 6 3 - Z V1- Z 2-7- 5 <br />Address: 2 c/ SZ 51f c r wuu4/%2c/ a <br />Years at this address: /.^Yearsnyou have lived in Mounds View: /3 _ <br />E-mail Address: _. �U G CS g p U S e 7'- <br />ualifications You Want to Have the Mayor and City Council Consider: <br />Skills and Interests: <br />Gay ./--yvu-AA llvd key Yyrr -b,.ys lyr—parr/s <br />Litt'/.Lw/er0Li IL/cLc,, cc yrs <br />,Mvv4c/a Vr a- CC,Yy .P� -r // 7 yr3 <br />Em loyment, Occupation or Other Experience: <br />,�r�Re�-Grcw7tR�varE�ir�y.- yyrs <br />Ti'i`leExw .i.er—[o..»tee ryrS <br />pu/U�ti j�urNCSd /tea — �/,j $e.aSona/ <br />Memberships, Accomplishments or Other Qualifications: <br />Please state your reason for wanting to serve with this group: <br />IO Ch/ta4t6 7`/• e�Dalr /k� s yr7tc/y �vr %�eii� ����mk (ase to ya flresr<l'e-r�.s, <br />�rOVide GL S -pe "44 7'Vh -Por kUs 7`a �1t�dectdnce/ lec<<+h Cchcl <br />exca l/, <br />Signature: ��• t-�- 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 Motmds View is committed to the policy fiat allpersons shall have access to its programs, <br />Facilities aid employment without regard for race, creed, color, sex, age, national origin or handicap. <br />