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Of <br />BRHTON <br />the city that uv,v�rks for <br />Advisory Commission & Task Force Application <br />Date <br />General Information <br />Name --j �Iqcc6SE&) s�ENiSE_ fj <br />Last First M.I. <br />Address <br />City, State ZIP <br />Phone l S <br />N Zw B cj,(+C MA) Ss Ila <br />G /� 77S-3o3Y <br />Email Address Jeo,"saI'0- sin 0- c6mOx! s+- n'+ <br />Commission/Task Force <br />Public Safety Commission <br />Planning Commission <br />Park, Recreation & Environmental Comm. <br />Availability all Preferences) <br />Preferences) <br />After work, early evening X_ Evening, after supper <br />List specific days or times you are not available <br />Personal Information <br />�s-/ -N - <br />Economic Development Commission <br />Civil Service Commission <br />NWQ Financial Strategies Task Force <br />Early morning <br />List any related work/education experience: f <br />/-2-ad POS' It"' --n 1 0q C.II MIC:, r; 1 f c-�G'�,7�Ci"� ,. �X oeri 2ne.a <br />p1' Cc'2a�1 ncy, �c�iG�2S c�n�` �r'�c ec�Ur�s„ <br />