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12 <br />FOR OFFICE USE ONLY A nge,14da. I-anpn <br />Q IoF2 <br />VOLUNTEER APPLICATION 0, <br />ORANGE COUNTY ADVISORY BOARDS AND COMMISSIO JM 2 d 29 <br />If you are an Orange County resident, at least 18 years old, and willing to vol <br />expertise to your community, please complete this application and return to-. <br />Orange County Commissioners' Office <br />P.O. Box 8181 <br />Hillsborough, NC 27278 <br />Phone (919) 245- 2125; 245- 2129; 245- 2130; 732 -8181 <br />�Fax: (919) 644-0246 • Emalll: nmartin@co.omng/e.nc.us <br />NAME:�lJ� <br />HOME ADDRESS: <br />CITY: �` Zip Code:, %2.J <br />PHONE: (Day) ��- 71-19- 20 %1 Evening/late) Q�9� 7,91 `267AFax) <br />EMAIL: AP-aAe -,4 CL A~% <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP <br />OF RESIDENCE: <br />D Bingham O Cheeks D Hillsborough D Eno O Chapel Hill <br />)y <br />Little River D Cedar Grove <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />D Joint Planning Area D Extraterritorial Area 17 Transition Area <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING QUESTIONS: D Male Female <br />ETHNIC BACKGROUND: b African American Caucasian D Hispanic 17 N erican <br />17 Other DATE OF BIRTH: <br />PLEME LIST (IN ORDER ■ - . - ENCE) THE BOARDSICOMMISSIONS ON • <br />W0jLD BE SERVE. <br />