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C <br />/ Group <br />APPLICATION FOR ADVISORY GROUPS <br />applied For: <br />Ciioice (if any): <br />Q <br />or type): <br />_ rac31+� �Qe S i 2 JQ YLSOr� <br />a�y7 �4;�a� 9due, m p Is eb-1,aa- <br />,t Thi� Address: Years You Have Lived In Mounc <br />Telephone: Home: eat-6 <br />-733in Wok or they: <br />QUALIFICATIONS YOU WANT '1'0 HAVE THE COUNCIL CONSIDER <br />Skills and Interests: <br />I cI,'Idr¢r� iu �``rb In cztrJ uoll lb <br />oY�er par{ f2 j !n �otl,i� r"� 3 <br />t 1oi 7 <br />ployment, Occupation or Other E pFJrience: <br />Spor fi goods so-M repr6wA a t, <br />r•==-s utner Qualifications: <br />I'�eoacA6l:�- q }'-AZ6J4 y- Lr s W&J,/ <br />A <br />Please State Your Reasons For. Wanting To Serve On CTh�is Committee: <br />(ullll [ r Cu � r G�� `liiG�� <br />611, <br />�u*¢o vcu <br />/ ound� U,ew, b . l�clr� inn�l liJtli `.{pie 1,C5l�rf- /n <br />Your response to any of the above may be continued on tho K.'1' <br />and you may arrec. c;,I oi.iier materials which you want the Council <br />to consider. <br />Signature gig�✓Yo-, Date 3-2S-Q? <br />The City of Mounds iew 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 />M <br />