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02/21/2000 21:37 9196443002 DR. CTY. PLANNING PAGE 02 <br />2 %2z /p° Q I oF2 Dale Georli de <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY BOARDS AND COMMISSIONS <br />If you are an Orange Oounty resident, at least 18 years old, and willing to volunteer your time and <br />expertise to your comrouniity, please complete and return to: <br />Orange County Commissioners' Office - P. O. Box Biel <br />Hillsborough, NC 27278 D Fax: ( 919) 644 -0246 <br />2 20 <br />NAME: ' Cv&MRG (,4p <br />1 <br />HOME ADDRESS: c.97t-S-A -A4 eEEK� f�D. <br />D_u 2[ 14 -W A) -C . Zip Code 2 7 7O. <br />TELEPHONE: (H) 3VA -8053 (W). (Fax) <br />EMAIL <br />PLACE OF EMPLOYMENT: <br />JOB TITLE: <br />IN ORDER TO ASSURP COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP OF <br />RESIDENCE: 8Ib9ham Cheeks <br />Hi�laborough Eno <br />C"apel Hill Little River <br />C4dar Grove <br />9 <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />JPA (Joint Planning Ar§a) - <br />EA (Extraterritorial Ares) UA <br />TA (Transition Area) <br />WE. ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, BY <br />ANSWERING THE FOLLOWING QUESTIONS: C,,4 • d1V <br />Maio ETHNIC BACKGROUND: <br />Female - X African American Hispanic <br />Caucasian X _ Other <br />Native American <br />DATE OF BIRTH: 11 t:1 <br />PLEASE LIST (IN ORDLR OF PREFERENCE) THE BOARDSICOMMOSIONS ON WHICH YOU WOULD BE <br />WILLING TO SERVE. <br />1. 41 S T-0 rzA G'1% t? - seT,&A, n Q f l c-.o M wlJS S i <br />2. <br />3. <br />F <br />