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APPLICATION FOR ADVISORY GROUPS <br />Groin— p Applied For: <br />Second Choice (if any):447,vle <br />nt o <br />Full Name (print� <br />e YY <br />Jr. �lYlY�l�17 <br />005` rove L A,vdZd , <br />Years At This Address:. Yeats <br />You Have 1.1i d, Mounds View: <br />Teleph� Home: <br />Z -0 <br />Work or Other: <br />4 - I <br />QUALIFICATIONS YOU WANT CO HAVE THE COUNCIL CON SIDhR <br />Skills and Interests: <br />Employment, Occupation or Other. Experience: <br />j)JO tiiA) McM6ev or -Police Cb)„i,, SSl•,✓� <br />1 ' IJYGGc� . CIV,l <br />- ujo:rKed d <br />n/CIC✓ l�Ol, (^.✓+ � soe'I,-ce 1%/o t WofG'OT <br />Miimberships, Accomplishments i Or Other Qualiiica•^ionsf <br />(/�(,tJ. ;_,L,d Ns _ isur �Gddi a — C'! 1'ry C'ou,✓,c i I — <br />Pl ase State Your Reasons For 'Wanting To Serve -On This Committee: <br />1TK <br />�� t'rese,✓f eays;`yn ssio.ci- Flee% 714'_ <br />Your response to any of. the above may he in on the bacTc- - <br />and you iay attach any other materials which you want the Council <br />to consider. ._ <br />Sign tur. -_, Gd!' 'Date <br />The City of )founds iew is committed to the policy that all <br />persons shall have equal acce:;r, to its programs, facilities, and <br />employment without regard to race, creed, color, sex, age, <br />national, origin, or handicap. <br />