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0 APPLICATION FOR ADVISORY GROUPS <br />Group V I1 /4L2&z /. LL &T,� <br />p Ad- Ak1 <br />second Choice (if any): / <br />Full Name (print or type): <br />�— <br />I, l-chr <br />: Iheresn ��►r� <br />Addresa: <br />Years At This Address: Years You <br />Have Lived In Mounds View: <br />5 l rs . <br />21 r 'i <br />Telephone: Hom <br />i'78l -281Z <br />Work or Othe_• <br />-- <br />u <br />QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br />ISkills and Interests: <br />(UIO�tC��ix1 : C 0 1f?l ��17� U�Wj <br />Employment, Occupation or Other JExpe fence: <br />a oi�t' IJ'D <br />is Or Other <br />n tP <br />y11Q t }'t{/21ti0 Y 4C/. W '- D"POVLLVM� <br />Please Stat ur He on For Wantin To S rve 9'his Commi,tte� <br />(5 am U�M �r -(� - .rTtz`Lt ( <br />�rY►�sut �� �, t�v�tQ.n.� CL <br />(Your esponse to any of ttYe above may be continued on the hack <br />and you may attach any other materials which you want the Council <br />to consider. <br />Siynature�y-)I ) Date Z <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 />