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I understand that �he City will not publish m� phone or fax num}aers or email address � <br />without my authorization and do hereby allaw �he Ci�y to �ublish (check all that apply).; <br />no� checked <br />Daytime Phane: <br />Evening Phone: __________ <br />Cell Phane: <br />�ome Phane {if different): <br />work �hone (i� different): <br />Home Fax:. <br />Work �ax: <br />Home Email: bradpeper@gmail,com <br />work Email: <br />5tudent App�ication: No <br />If yes, please list your grade: <br />May we con�ac� you using your work email or fax?: No <br />I have read and understand the stat.ements on �his form, and I hereby swear or affirm that <br />�he statemen�s on �his torm.are true. : Yes <br />A�dit�onal Informationz <br />Form submitted on: 2/2�/2009 �2:52:12 PM <br />Submitted from IP Address: <br />Form Address: http://wws�.ci.roseville_mn:us/forms.asp?FID-237 <br />� <br />