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2009_0309_Packet
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2009_0309_Packet
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1/6/2012 2:47:18 PM
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4/20/2009 1:00:28 PM
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I unders�and that the City will not publish my phone or fax numbers or email address <br />without my authorization and do hereby allow the City to publish (check al1 that apply).: <br />H.ome telephone number, Hame email address <br />Daytime Phoner 645-6161 <br />Evening Phone: as above <br />Cell Phone: <br />Home �hone {if diffe�enta: <br />Wor� Phone (if differenta: <br />Home Fax: <br />Work Fax: <br />Home Emai�: ggrefenberg@camcast.net <br />Work �mail; as above <br />Student Application: No <br />If yes, p�ease lisC yaur grade: <br />May we contact yau using yaur work email or fax?: Yes <br />I have read and understand the s�at�ments on this form, and I hereby �wear or affirm that <br />t�e statements on this fozm are true. : Yes <br />Additional Infarmation: <br />Form submitted on: 2/27/2009 2:29:41 PM <br />5ubmitted �rom TP Address: <br />Fazm Address: http://www.ci.roseville.mn..us/forms.asp?FID=237 <br />� <br />
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