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Any further information you would like the City Council to consider or that yau feel is relevant to the appointment you are seeking.: I understand that a11 information provided in �his applicatzon, except my telepnone nurnber, fax nuinber and email address, may be distribu�ed by the City to the public includ�ng, but not limited to, being pasted on the City of Rosevil�e website. I agree to waive any and all claims under the Minnesota Government Data Practices Act, or any other applicable state and federa� law, tha� in any way re�atEd to tihe dissemination to the public of informatian contained in this application that would be classified as private under such laws. I understand �hat z may con�ac� the respons�ble authority far the City of Roseville if I have any quest.ions regarding the public or private nature of the information provided.: Yes i understand that the City will not publish my phone or fax numbers or email address without my authorizatian and do hereby allow �he City �o publish {chec� all that apply}.: not checked Daytime Phone: Evening Phone: Ce11 Phone: Home Phone (if dif�erent): Work Phone (if differenti: Home Fax: Work Fax: Home Email: Work Email: Student Application: No If yes, please list your grade: May we con�act yau using your war� email or fax?: Yes I have read and understand the statements on this form, and I hereby swear o� affi�m tha� the statements on this form are true. : Yes Addztional Int.ormation: Form subm�tted an: 2/27/2009 3:31:30 PM Su�mitted from �P Address: FoYm Address: http://wwW.c�.zoseville.mn.us/forms.asp?FID=237 i'a