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<br />FOR OFFICE uSfi ONLY <br />~~6~ l ~ ~~ -~ o ~2 `~ctvnm~l S cods <br />VOLUNTEER APPLICATION <br />ORANGB COUNTYADVtSORY 80ARDS AND COMMISSIONS <br />ff you are an Orange County resident, at least 18 years old, and willing to volunteer your time and <br />expertise to your community, please complete this application and return to <br />NAME: ~-_~ <br />HOME ADDRESS <br />L~re~, f ~y~,~c.~c~.~ <br />CITY• _ ~ r~~' ~ Zip Code: ~ IJ ~~ <br />PRONE: (Day) ~~~~~;~; ~ (Eveningnace) ~i9 - ~-q4 7S ~~ '~~S- ~~ <br />EMAIL: ~f~~~7~1 ~ShU~CY~.yifi~~` - <br />PLACE OF EMPLOYMENT: ~LtSc.C~_/n.~ILaL-.c~idl i2 ~d JOB TI7'L.E: ~' 43 <br />!N ORDER YO ASSURE COUNTYWIpE REPRESENTATION PLEASE lNbICATE YOUR TOWNSHIP J - <br />OF' RESIDENCE: ' <br />D Bingham D Cheer ^ Hillsborough D Env ^ Chapel Hill D Little River ~ Cedar Grove <br />IN ADDITION, PLEASE INDICATE 1F YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />d Jaint Planning Arsa ^ Extraterritorial Area O Transition Area <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSH HY AGE, GEND7=R AND RACE, <br />BY ANSWERING THE FOLLO~il11NG QUESTIONS: ^ Male L9`Famate <br />ETHNIC BACKGROUND: rican American D Gaucaslan O Hispanic ~ IW ve American <br />D Other DATE OF BIRTH: '~ <br />PLEASE LtS~' (IN ORDER OF PREFERE~NC~E)~T~HE BOAR,DSL/COMMISSIONS ON Wt•IIGH YOU <br />WOU1~I>^~E IL 7~ T ER~/E. 2. ~i~M`,! -~~~ Hl -~~ 3. <br />WORK i=XPERIENCE: ~~~Y1'[~~61i~(lt O <br />db~/ <br />5c <br />0.~ <br />~~fs/ <br />Orange County Commissioners' Office D ~ ~ ~ u'U« \ <br />P.O. Box 8181 1/ <br />Hillsborough, NC 27278 ;~ ~ 8 <br />Phone (919) 245.2425; 245 2129; 245-2130; 73x•8181 <br />Fax: (919) 644-0246 • Email: nmartin(~coorange.nc. <br />_ -Tn,-,Lc ~--. . <br />w=tLi(s <br />u. = ~ It <br />