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t^. <br />APPLICATION FOR ADVISORY GROUPS <br />Group Applied For: <br />Second Choice (if any): <br />Full �I' pK nt or type); ' <br />Address: ; <br />Yeas At This Address: Years You Have <br />Llvecl In Mounds View: <br />Telephone: Home: SVork or Other: <br />QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br />Skills and Interests: <br />• ...r /YrCI,•' rG' r .</_'� c �«i:;'•�-•n2, ��;•cLj�lr <br />Employment, Occupation or Other Experience: r"�-- <br />Ll <br />Memberships, Accomplishments Or Other Qualifications <br />cavaaa a,a La LvuL measons Cur Wanting To serve On This Committee: <br />�'CL LC ! C.'L LCJ r_-� .0 • f? ?c i �za°� -r i �'12 <br />Ir <br />Your response to any of the above may be continued on the back <br />and you may attach any other materials which you want the Council <br />to consider. <br />Signature / Date 7 <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, ape, <br />national origin, or handicap. <br />