HomeMy WebLinkAboutParks and Recreation Application - Cindy PalmCity of Mounds View
2401 Highway 10
Mounds View, MN 55112
(763)717-4000
Application for Advisory Boards and Commissions
Group Applied for:
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Full Name (Please Print): //I
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Home Phone: ff3 -�_`J Work Phone: �� �c�� S `� -71
Address: Feil—rrt C bri V-efilUL�U'IC4S V l •� %�i /V ��
Years at this address: o /Z—
E-mail Address: 40 Z -
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Years you have Iived in Mounds View: � ( _
ualifications You Want to Have the Mayor and City Council Consider:
Skills and Interests:
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plo�yfinent, Occupation or Other Experience: Gz
Memberships, Accomplishments or Other Qualifications: �?' e_`
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Please state your reason for wanting to serve with this group:
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Signature: Date:
(Your response to any of the above inquiries may be continued on the back of this form and you
may attach any other material that you would want the Mayor and Council to consider.)
The City of Mounds View is committed to the policy that all persons shall have access to its programs,
Facilities and employment without regard for race, creed, color, sex, age, national origin or handicap.