HomeMy WebLinkAboutParks and Recreation Application - Darren PetersonCity of Mounds View
2401 Highway 10
Mounds View, MST 55112
(763)717-4000
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Home Phone: -945 01;03 . .. Work phone.. -7613- 9-5-2 Z13�
Address: Dail r� --
Y=s at this address:, 2— 'Rears you have lived in Mounds 'View: '3
E-mail Address: e Co An ca'� A Lqo
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�Lualifcatioris You Want to Have the Mayor and City Council Considen
Shills and Interests:
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Mernberps, ,A•ccomplishthunts or Other qualifications"",
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Please state your reason for wanting to serve with this group:
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Signature: o^V Date: Z "
(Four response to any of tete above inquiries may be continued on the back of this foarM 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 hm+e access to its programs,
,Facilities and employnient Mthoilt regard for race, creed, color, sex, age, national 011gin or handicap.