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0 <br />U <br />APPLICATION FOR ADVISORY GROUPS <br />Group Applied <br />For: r <br />Second Choice <br />(if any): <br />pull Name((print <br />or type): <br />Address: <br />Years At This <br />Address: Years <br />You Eave L ved In Mou <br />Y d��View: <br />15 voU:"5 <br />Tesephone: Homei <br />Work or Other: <br />QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br />Skills and Interests: c, ,\ -.:.; ol�'' <br />,�o.`.�-1,\r <br />Employment, Occupation or Other Experience: <br />Memberships, Accompl_shments-Or Other Qualifications: <br />C <br />Please State Your Reasons For Wanting 'To Serve On This Committee: <br />Your response to any of the above may be continuea on cne ua— <br />and you may attach any other materials which you want the Council <br />Date ' & �3 l <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 />