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® APPLICATION ?OK ADVISORY GROUPS <br />Choic�any) <br />ame (P <br />r..nt or tYPe)= <br />1_ <br />s:JO 7 no/l <br />ddress years <br />At This A <br />:one: Home: c;v-7/77 <br />T TO HAVE THE COUNCIL COtl"Dgg <br />QUALIFICATIONS y0U WAN <br />ly o..- - 'n <br />8'Q r8rrt <br />a,C / b/h-7c ma f�rsy A..K <br />y and 0•1P U <br />irvoentl `Dcrc�upatio/n or �J4,.— M <br />gym Sh /sort : • '1 <br />0 <br />nce: <br />ad 'r, I <br />f <br />Other oua/i/ Eicationsc <br />lishments Or , f Ku *O^Q " <}Y. <br />rYO�Iaay <br />ps Accomp SO<,e y, G'.li/% /%J4. .' riCr�ela`Jbrr��.•"•�nCtr O! D��CR: r1N Geu�DntteWanting To Serve easons For .nr^J4; '=Sve%ate youY R r0^ o sh°�r L�f nl/h/,°^ °bcontinued otne ckto any oabove maY which you wa"t the Council <br />ponSe other materialsmay attach any to cder. Date �- <br />- that all <br />Signature ;tied to the Policy <br />is coftu its programs, facilities, and <br />of Mounds equal access to creed, color, sex, ag., <br />The City ns shall have equal <br />to race, <br />employment without regard <br />employment or handicap• <br />national origin, <br />7 <br />