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without my authorization and do hereby allaw the City to publish (check a11 that apply}.; <br />Home telaphone number; Home email address <br />Daytime Phone: 651/645-6161 <br />Evening Phone: as abave <br />Cell Phone: <br />Home Phone {if different): <br />Work Phone {if differen�): <br />Home Fax: <br />Work Fax: <br />Hom� �mai�: ggrefenberg@comcas�.net <br />Work Email: as above <br />Student Applicationi Na <br />It yes, please list your grade: <br />May we contact you using your wo�k email ar �ax?: Yes <br />r have read and understand the statementis on this farm, and r�ereby swear or af�irm that <br />the statements on this form are true. : Yes <br />A�ditional Infarmation: <br />Form submitted on: 2/27/2Q09 2:57:28 PM <br />Submitted from IP Address: <br />�orm Address: nttp://wWw.ci.roseville.mn,us/forms.asp2EID=237 <br />2 <br />