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Any further information you would like the City Council to consider or that you feel is relevant to the appointment or reappointment you are seeking,: I understand that information provided in this application may be distributed by the City to the public includin , but not limited to, being posted on the City of Roseville webs,ite. I agree to waive any and all claims, under the Minnesota Government Data Practices, Act, or any other applicable state and federal law, that in any way related to the dis,s,emination to the public of information contained in this application that would be Classified as private under such laws,. I understand that I may contact the responsible authority for the City of Roseville if I have any questions, regarding the public or private nature of the information provided.: Yes, Occasionally City staff gets, requests, from the media or from the public for ways, to contact Commission members,. The Commission roster is periodicaly made available. Please indicate which information the City may release to someone who requests, it or that may be included on the Commission roster. Under MN Statute §1,2.601. s,ubd. 3(b), either a telephone or electronic mail addres,s, (or both) where you can be reached must be made available to the public. Please indicate at least one phone number or one email addres,s, to be available to the public., and fill in the corresponding information in the below.: Home Phone Number rer, I =-D Men i W', I Preferred Email Addres,s,: I have read and understand the statements, on this form, and I hereby swear or affirm that the statements, on this form are true. : Yes, Additional Information: Form submitted on: 1,2/1,5/201,0 1,1,:1,3:35 AM Submitted from IP Addres,s,: Referrer Page: http: //sn143w. sin 't143.mail. live. com/mail/lnboxLight. asp M=1838362960 Form Addres,s,: http: / /www. c ityofrosevi 1 lei. com/forms . aspx?FID=237