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f <br />APPLICATION FOR ADVISORY GROUPS <br />Group Applied For: ��n ,W� <br />Second choice (if any): <br />Ful Namn (pr nt or type s� 9 <br />40 <br />Years At ThTs Address: 4 Years You Rave Lived In Mounds Vlew: t <br />refl lione: Ilomes� ®��y�, Work ur Uthers�t/ ® <br />QUALIFICATIONS YOU WANT TO HAVE TIM COUNCIL CONSIDER <br />Skiryand Interests: <br />- <br />EmPI�� cup ton o_ r QtliJIr lixpsrience: <br />Memberships, Accomp shments O her Qualifications: <br />&4 <br />Please State Your Reasons For wanting5_ervn is <br />Please Committee: <br />edtviA�.�va�t�►: <br />�d on the back <br />Your response to any of the abo.n may bo contlonuswant the Council <br />and you may at�x►�+i�ott:or. matorials which <br />to consider,( ��_ ) <br />� aww <br />"'1 Dateq 1VAT& <br />Signature <br />The City r° Mounds View s •ommiCtnd to tho Policy that all <br />persons shall have equal .ccess to Its programs, facilities, and <br />employment without regard to race, creed, color, sex, ago, <br />national origin, or handicap. <br />