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APPLICATION FOR ADVISORY GROUPS <br />Group Applied <br />For: <br />%/iSlr <br />`yACC eon, Lie „s.fTrc:, <br />Second Choice <br />(if any): <br />Full Name (print or type): <br />r-AA <br />ulI <br />Address: <br />S73-j C.•_bcT <br />/M <br />Years At This <br />Address: Years You Have Lived In Mounds View: <br />S <br />5— <br />Telephone: Home: 7b•y-5•i31 Work or Other: <br />64y-3377 <br />QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br />Skills and Interests: <br />Employment, Occupation or Other Experience: <br />Memberships, Accomplishments <br />Or Other Qualifications: <br />i <br />I <br />PleaseStateYour Reasons/ For <br />To Serve On <br />Wanting This—Com1mittee: <br />Your response to any of the <br />above may be continued on the back <br />and you may attach any other <br />materials which you want the Council <br />to consider. <br />Signature��/��//� i Date ) Z3 / - <br />I <br />The City of Mounds View 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 />1 <br />L&s <br />1 <br />