Orange County NC Website
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/o <br />FOR OFFICE USE ONLY ' <br />I Z5 al a lcF2 34 ins, iialrnan —Lon, <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS <br />If 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 applicatich and return to: . <br />Orange County Commissioners' Office <br />P.O. Box 8181 D <br />Hillsborough, NC 27278 <br />Phone (919) 245 - 2125; 245. 2129; 245-2130,732-8181 JAMN 2 5 2001 <br />Fax: (919) 644 -02 •Email: npaciga@co.orsnge.nc. <br />NAME: <br />HOME ADDRESS• ,,pp <br />CITY: C/ Zlp Code: <br />PHONE: (Day) (Evenfngllate) _ (Fax) <br />EMAIL' <br />PLACE OF EMPLOYMEN . <br />IN ORDER TO ASSURE COU DE REPRESENTATIION PLEASE INDICATE YOUR TOWNSHIP <br />OF RESIDENCE: <br />O Bingham O Chaska Hillsborough O Eno O Chapel Hill O Little River O Cedar Grove <br />IN ADDITION, PLEASE INDIP4 M, IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />O Joint Planning Area W Extraterritorial Area O Transition Area <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHI AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLJL�G QUESTIONS: O Male Eff f=emale <br />ETHNIC BACKGROUND: W African American O Caucasian O Hispan' American <br />O Other DATE OF BIRTH: <br />PLEASE UST ON ORDER OF PREFERENCE) THE BOARDSICOMMISSIONS ON WHICH YOU <br />WOULD BE WILLING TO SERVE <br />