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'I~ <br />CITY OF NEW BRIGHTON <br />803 - 5TH AVENUE N. W. <br />NEW BRIGHTON, MN 55112 <br />Ig~'tt011 633 - 1533 <br />APPLICATION FOR ADVISORY GROUPS <br />GROUP APPLEED FOR: <br />C <br />~ <br />~... d IU ~o ~ O Wl.i'Yt, t ~' S E <br />~"~ ~ <br />SECOND CHOICE (IF ANY); <br />FULL NAME (PRINT OR TYPE ): <br /> <br />ADDRESS: <br />` <br />~ <br />J <br />- l <br />t U / s E t; <br />YEARS AT THIS ADDRESS: YEARS YOU HAVE LIVE NEW BRIGHTON: <br />~ <br />s yam. s <br />a- <br />TELEPHONE: HOME: WORK OR OTHER: <br />t~3~- B'39 <br />QUALIFICATIONS YOU WANT TO HAVE THE COUNCIL CONSIDER <br />EDUCATION: <br />~A - J rs wR U R~-~ S rr~ , t~ . vF mN ~t`xf~~ct-EQ l a-~i) <br />EMPLOYMENT, OCCUPATION OR OTHER EXPERIENCE: <br />t- ~ 1 'y`-o ~ _ ~' ~ .. p LL t3 ~ ~ c , N F o ~ M r~r/ o •~ <br />IW? ~RIV SN ~ P~ S~A-TS ~~AT. of Ce~~2~~?yOh?S <br />MEMBERSHIPS, ACCOMPLISHMENTS OR OTHER QUALIFICATIONS: <br />~. r r~ C~ ~ >E ~~ ~®.r• a ~v u o T~,e s vfi ~v Fw 'r~ R / ~ /~ ~o~ <br />CcZ-~ ~-t NS E. ~ RG~~,E C /°~4ST' PRtS~D~NT' <br />PLEASE STATE YOUR REASONS FOR WANTING TO SERVE ON THIS COMMITTEE: <br />r{ t9v E Fut. ~.O cv L~ U ~' v t~ ~ ?-$ I~ £ 6 A R 4 ~ k~ G ~ tS <br />Ppr R~ w ~~rrt ~ee~- ~ w~--~ ~~ sT- i~ P K o ~~ 0 ~ u G <br />04 ~~ C ~E t41~ ON~9 < ~ ~ SG ~ R G ~ 14 vt4 i ~- A Q~ t /4d1~ <br />VAI..u-.AK{L~ 'r0 04LL ~ES/4EN?S OF ?'tiF COI'Nt/i'tu.llrT~ <br />YOUR RESPONSE TO ANY OF THE ABOVE MAY BE CONTINUED ON THE BACK AND YOU MAY ATTACH ANY OTHER MATERIALS <br />WHICH YOU WANT THE COUNCIL TO CONSIDER. <br />SIGNATURE ~~~ A"~~ • - - ~~h~' DATE u ~ ~ " ~~ ( - <br />THE CITY OF NEW BRIGHTON IS COMMITTED TO THE POLICY THAT ALL PERSONS SHALL HAVE EQUAL ACCESS TO ITS PROGRAMS, <br />FACT CITIES, AND EMPLOYMENT WITHOUT REGARD TO RACE, CREED, COLOR, SEX, AGE, NATIONAL ORIGIN, OR HANDICAP. <br />