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Jtv—r , d Z' <br />APPLICATION FOR ADVISORY GROUPS <br />Group Applied For: <br />rat <br />Imo! <br />d(� O Cmlllsc"0 1 <br />Seco— d ChoTEe (if <br />n <br />any): <br />Cu 1 Name (print or type): <br />Address: 8335 <br />SP�I/i� <br />11iF ���� <br />Years At This Address:I,, <br />Years You Have Lived In Mounds View: <br />Telephone: 11omet <br />Work or Other: <br />QUALIFICATIONS YOU WANT 'r0 HAVE THE COUNCIL CONSIDER <br />Sk lls and interests: <br />✓(, OPS1G'� <br />(CKCyRui^Ia �'� <br />AF-QtITEcTR <br />Employment, Occupat on or Other Experience: <br />C)k^Ifirf- of 0A6fyFT Q6P <br />Membe's r)s, Accompl shments Oc other pualiEi,ations: <br />Please State Your Reasons For Wanting To Serve On This Committee: <br />�TWF.q rj <br />%e-,INtr lei, cvo1� Grt -Ts <br />�kS <br />PAP �i<1y�i�1c� �F_�ecr4khE: <br />Your response to any oC tthe above may be continued on tho back <br />materials which you want the Council <br />and you may attach any other <br />to consider. <br />Signature (��_�ei>-- Date <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 rare, creed, color, sex, age, <br />national origin, or handicap. <br />