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nox <br />TOWN OF HILLSBOROUGH ' <br />BOARDS AND D COMMISSIONS <br />If you are a Hillsborough Town resident, at least 18 years old, and willing to volunteer <br />your time and expertise to your community, please complete this form and return it to: <br />Town of Hillsborough <br />Clerk's Offrce <br />PO Box 429 <br />H lsboroogh, NC 27278 ^� <br />1'1t s � CIP.rt CQ : V i Gi U ri C�. 1J f ► v'C� <br />a. i' ':�':ax� r N _ <br />=,,,r, a.i . �fy£7.ry 5,.�i�'f� .. i�.�r -'H' r :jci'���,'` <br />�.'•ryc •i-^.r ". :. <br />P <br />'r1� #4•?'4,'�•f.1' `..i�,;r�'_,,�;�i C,:'.:. r��'++1 ''�.0 - �• c4;:.i:i'_'' „'� —y '4r. ...,.-_.:. <br />' �T�} � �('1 - ,-,=.� ar'-• _.*•-•+ c�' <br />-�- ^a' '. �; C: �'' tL�l' T�` L' :TiT+a:'_'a'SZ..y�:4�iT.:r�l?•• <br />-:-. , ,y. , Z'+p� <br />:R'N[jar.•'�"�i:v� �T.n.�'�'•n'� -' T' <br />l <br />NAME <br />ADDRESS CITY Sr ZIP <br />° JOB Trn-E <br />PHONE (HOME) <br />CE O EMPL.OYM' <br />WE ASK YOUR ASSISTANCE IN ASSURING DIVERSITY OF <br />MEMBERSHIP BY GENDER. _AGE AND RACE. BY 'r <br />SEX MALE FEMALE <br />ANSWERING THE FOLLOWING OUESTTONS. <br />AFRICAN AMERICAN <br />DATE OF BIRTH <br />-ZCA.UCASIAN _HISPANIC <br />_ NATIVE AMERICAN _ OTHER (SPECIFY) <br />PLEASE CHECK THE BOARDS/COMMtSS1ONS/COMMM -EES ON <br />f� BOARD OF ACULIS MENT TOURISM BOARD <br />TREE Bomo Hwomc DIsmcT <br />WHICH YOU WOULD BE WILLING TO SERVE. %r <br />PLANNING Bawd PARKS ANo RECREATION <br />OCCONEECHEE PARK COMMITTEE <br />ENTRANCEWAY COMMITTEE,�.• <br />- <br />PLEASE UST YOUR REASONS FOR WANTING TO SERVE <br />t <br />PLEA-+E LIST ANY WORK. VOWNTEER. AND /OR EDUCATIONAL <br />RK IX I E I <br />fXPERIENCEYOU WOULD LIKE TO HAVECONStDERED IN THE <br />REVIEW OFYOUR APPLICATION. <br />a4e. <br />c (`i <br />E: <br />Cj <br />At <br />HOW DID YOU BECOME AWARE OF HILLSBOROUGH'S K" <br />PAPER (SPECIFY) <br />CURRENT HILLSBOROUGH VOLUNTEER tSFECIFY) <br />VOLUNTEER OPPORTUNITIES? <br />_ <br />RADIO (SPECIFY) <br />TELEVISION (SPECIFY) <br />OTHER (SPECIFY) <br />NAPPOINTED, 1AGREE THAT I HAYS THE AVAILABLE TIME REQUIRED AND WTLLINGIVESSTO SERVE TO THE_ BEST OF MY <br />ABIL <br />(s�r� (Date) <br />