Agenda - 05-06-2003 - 9-d-4 - Laserfiche WebLink

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FOR OFFICE USE ONLY -'~•.- o ~ dh~n P t r, ~ ~' /Co VOLUNTEER APPLICATION ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS If you are an Orange County resident, at least 18 years old, and wilting to volunteer your time and expertise to your community, please complete this application and return to: 2 ~'-" nn"'- • Orange County Commissioners' Office D L5 LJ_ (f{ P.O. Box 8181 ~~ Z=-~ L~J ~ !~ Hillsborough, NC 27278 , t Phone (919) 245-2125; 245-2129; 245-2130; 732-8181 ~/ r~Fax: {919) 644-0246 • Email: ncglover@co.orange.nc.us NAME: ~E~ (R.~~~C,~ HOME ADDRESS: ZZE~j ~. WtL.G.p~•r Q~ CITY: C-~l..~J~ N~ Zip Code: 2'7?J~?j PHONE: (Day) ~(~ .~jh?j 1(-ll~'(Evening/late) (Fax) EMAIL: ~pf'~rrt~t~i01 ~ ~u~c3D1'U~f • ~'~Wt PLACE OF EMPLOYMENT: JOB TITLE: l~let, ~1 IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP OF RESIDENCEi ^Bingham heeks ~hiilsborough ^ Eno ^Chapet Hill ^Little River OCedar Grove tN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: ^Joint Planning Area OExtraterriforia! Area DTransition Area WE ASK YOUR HELP IN ASSURING DNERSITY OF~MBERSHIP BY AGE, GENDER AND RACE, BY ANSWERING THE FOLLOWING QUESTIONS: Male ^Female ETHNIC BACKGROUND: ^African American ~Caucastan ^Hispanic ^Native American ^Other DATE OF BIRTH: f t - 9 - ~f+(i ' PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMlSSIONS ON WHICH YOU WOULD BE 1MLUNG TO SERVE. ~MG~i~-rc5 r~K ~~ '!. 2. ~~r~~ZarJ s'~ijr~G'i 7~Wf 3. WORK EXPERIENCE; EXPERIENCE: I vi~:~ X11 Grt.t- ~ ~ ~~ ~ ~ ~rtr~ D , ~. _ .,