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10-\ <br />APPLICATION FOR ADVISORY GROUPS <br />Group A plied For: <br />f� <br />Second Choice (if any): <br />Full Name (print or/type): <br />Address: <br />Years At This Address: Years <br />You Have Lived In Mounds View: <br />Telephone: Home: <br />Work or Other: 73'6-.?zo <br />QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br />Skills and Interests: <br />Employment, Occupation or Other Experience: <br />Memberships, Accomplishments Or Other Qualifications: <br />Please State Your Reasons For Wanting To Serve On This Committee: <br />j!.,�/,� <br />Tie Ceiiin:ultly <br />Your response to any of the above may he continued on the back <br />and you may attach any other materials which you want the Council <br />to consider. <br />Signature lh�!(>j Date <br />/ <br />The City of ounds View is committed to the policy that all <br />persons s 11 have equal access to its programs, facilities, and <br />employment without regard to race, creed, color, sex, age, <br />national origin, or handicap. <br />