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Vyl> <br />APPLICATION FOR ADVISORY GROUPS <br />Croup Applied For: <br />✓� <br />-t`"""r%L�(1�✓ <br />Secondd—l'�,oic� (If any); <br />Pull Name (print. or type): <br />ILI <br />Address: , ,1. <br />-- �J ___%;_1 � Cyr- <br />Ycars At This Address: Years You <br />Ilave Lived In Mounds view: <br />alcbhune Ilome: <br />or <br />Work or otter : <br />370 <br />QUALIFICATIONS YOU WANT TO IIAVE' 'I'IIU COUNCIL CONSIDER <br />Skills and Interests: <br />c�.��tpu� l�fc Ir�.b�(� t,•n 5U1��meJ� . fit' ��it� <br />Employment, O'6upation o I:her Experi-ince: Nv <br />L1_)0 U cf ins+ L((iz �� v I V :�I vc' F S I7s p fv <br />dbc.(Jn'1 CLL)-Y)(.(.c. l <br />1'�.A • Le-, Pmc��tC�1( 5eutiC:L SOY U 64' Yn - <br />Ilemberships, Accomplishinents Or Other Qualifications: <br />gCtr aC(t 0y-),.Pe� n me 9& I VCLLOL tij �/nU j Z-C, <br />all <br />Please State Y u.- Reasons For Wanting To Serve On This Committee: <br />hlLtl2 P0.t `fCCc�i fCCi uY) <br />Your rpsponsd 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 TM q(�Calth Date ) -'Z-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 rare, creed, color, sex, age, <br />national origin, or handicap. <br />WO <br />