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C <br />APPLICATION FOR ADVISORY GROUPS <br />Group Apptiea ror: <br />Second —Choice any): I N <br />Full Name (print or type): <br />Address: P�33S S(� � F'6-AD <br />Years At This Address. Years You Have Lived In Mounds View.-.., <br />�— Work or Other: <br />Telephone: ilome: '78 <br />r .1U? f <br />OUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER _- <br />SkillsrA�and Interests: <br />"16 7I ��I1fC7�1 Pit, OFSI� <br />Employment, Occupation or Other Experience: <br />rshtps, <br />Other <br />Please State Your. Reasons For Wanting To Serve On This Committee. <br />ST t'i �✓i`i( Qh�f�T/o'� %�� GTi s <br />Your response to any Of the ahnve may ne continued on the back <br />and you may attach any other materials which you want the Council <br />to consider. <br />. � Date <br />Signature _— <br />The City Of Mounds View is committed to the policy that all <br />persoi,.% shall have equal accessto <br />itscreprogramsd, color, facilities, and <br />employment without regard <br />national origin, or handicap. <br />