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V2111 APPLICATION FOR ADVISORY GROUPS <br />Group Applied For: <br />Second Choice (if <br />Ful Name print or type <br />Address: 7�Q /_riP r r <br />�c��1 54-ra-+*c rod !, � (b ionr n <br />Years At This Address Years You HavP Lived In Mounds View: <br />r Ptl <br />Telephorie. Home—.- <br />+1,— eT----- <br />-.r 4�_ l�T l •� Work or Other; <br />5' 7N - ;cod <br />QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br />Skills and Interests: <br />uJ i-1 K PQOP(e, �tha-t'5 M�u91Vj n l o�W�Lk-) MIL <br />_i1Q, <br />IEm to p — .� ; 5. cL 7CCr -Yf) <br />p ymont, Occu Occupation or Other Experience;• <br />blY a�C'��1�!l (iOh i 5 real <br />rhe.rr; nCh RecI-l4y . ,rw'or-K1.d hand <br />LU3iyle 55 pPDDh° I2cZ�%�P / / <br />Memberships, Accomp shments Or Other Qua a ions : rich ^ <br />al,5v L (714ed 5eUc- gear-5 -For- �-/I <br />- ire %ten -7-CZ 01 Ltj -'e, tea_ �'ste P ease State Your Reaacns For Wanting To Serve On Th s Committee: <br />Scc;o�.(dc�b�tn r�a✓f lec�,5c�, 7LO bC r� <br />44ou <br />�a%he,xo.r respf�IeG�bove � <br />may be continue on the back <br />and you may attach any other materials which you want the Council OC��t^ <br />to consider. <br />Signature <br />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 race, creed, color, sex, age, <br />national origin, or handicap. <br />60 <br />