Laserfiche WebLink
Øcityor <br /> BRGHM\ <br /> the city that works for you <br /> Advisory Commission Application <br /> Date 15' -LW_ 2611 <br /> General Information <br /> Name kst Pc 1 rn ti M avt <br /> Last First J M.I. <br /> Address Oql Qt%t( titrb7)41I`V�— <br /> City, State ZIP Ni otA) I - 1/1 tletni ► 'c`Iv �J(�Z <br /> Phone & S , 2y.1. 4tD4-0- <br /> Home Business Cell <br /> Email Address YV\ V-V1 KLA vied/1 (it) J IM lc i - C o—rn <br /> Commission/Task Force <br /> Public Safety Commission X Economic Development Commission <br /> X Planning Commission Civil Service Commission <br /> Park, Recreation & Environmental Comm. <br /> Availability (Check all Preferences) • <br /> )C After work, early evening )C Evening, after supper Early morning <br /> List specific days or times you are not available <br /> Personal Information <br /> List any related work/education experience: <br /> a l(� �ew►•� Oa% vt mutt Dernivijo - --t t 1 - Rclooi rnsd?LCe <br /> 4 IL yeal,s old t3A04-t hoe Ceda.yS 1-I11er, NE VPiS <br /> I. Veit Y et IYY t.4 r - i 1441 Chu vi <br />