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q /�� 9\ p1�j %lavl <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY BOARDS AND COMMISSIONS <br />If you are an Orange County resident, at least 18 years old, and willing to volunteer your time anc <br />expertise to your community, please complete and return to: <br />Orange County Commissioners' Office 1 <br />P. O. Box 8181 �. <br />Hillsborough, NC 27278 <br />NAME: &&a GacAN <br />HOME ADDRESS: /8 30 mcaf Ali! Rb <br />EFinya A/c Zip Code z ?ZYY <br />TELEPHONE: (H) 6 Yy 6 y 83 (VV) 6 yy- GoGg (F) C Yfr- 75-v6 <br />EMAIL r h%y ! M;,4d&, -;4q . com <br />PLACE OF EMPLOYMENT: -M-f- E.•hco o 6Ro h.�ov�v �'�"'r �• -To~ A' ,vet c. <br />JOB TITLE: C-6.0 rono~ ,7-4,wry/ ,rs w•Fcoro . <br />ON REVERSE SIDE LIST JOB, VOLUNTEER, AND EDUCATIONAL EXPERIENCE AND /OR SKILLS YOU <br />WOULD LIKE FOR US TO CONSIDER. <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP OF <br />RESIDENCE: <br />Bingham Cheeks <br />Hillsborough Eno <br />Chapel Hill Little River <br />Cedar Grove <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, BY <br />ANSWERING THE FOLLOWING QUESTIONS: <br />Male <br />Female <br />DATE OF BIRTH: <br />ETHNIC BACKGROUND: <br />African American <br />Caucasian <br />Native American <br />Hispanic <br />Other <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS /COMMISSIONS P WHICH YOU WOULD <br />BE WILLING TO SERVE. O <br />1. ism11C p.� tlGtytTJb t/ CsHw..tsio N <br />2. <br />3. <br />