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Ik,-11 <br />lip, <br />J APPLICATION FOR ADVISORY GROUPS <br />Group Applied For: <br />i <br />Second Choice (if any): , <br />Full Name pr nt or type): <br />— <br />Address: 2?90 , )I)1e ll�('j_�^ /1 <br />i)nGl'y� <br />Years A: T is Address: Years You <br />r <br />Have Lived In mounds iew: <br />ITeleohone: <br />Work or Other:o' <br />.oma <br />QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL. CONSIDER <br />SY.ills and Interests: <br />CQ am/Kj rr�� tt cell <br />62 Cyynn� <br />Erployment, Occupatio o�r/Othper/ Experi n e• <br />Memberships, Accomplis nent% Or they Qualifica7 <br />Qx,sKa Cv� tY�av� , wY�a doyia� u <br />Please State Youc Reasons For Wanting To S.erlve On This Committee: <br />C� iliaL q �.0 LO i q `f lli CCsrnYn� r� t? <br />d �� 1 <br />Your response tc any of the above may be continued on the bock <br />and you may attach any other materials which you want the Cuincil <br />to consider. <br />Signature al:phm )"Adj (J.QrYXi1t Da to <br />The City of Mounds View is committed to the policy the 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 />