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FOR OFFICE: USE ONLY <br />3IS /� P o F 2 Leti+o-3ean Burns <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY ADVISORY BOARDS AND <br />If you are an Orange County resident, at least 18 years aid, and wllllng to volunteer your tin» and <br />expertise to your conrnunity, please complete this application and return - _ -- -� <br />Lj <br />Orange County Cormnissloners' Office 1 ; <br />P.O. Box 8181 , <br />Hillsborough, NC 27278 MAR 5 2U�� <br />Phone J91 0) 245 -2125; 246.2129; 2411`2190; 732 -8181 �) <br />II <br />Fax (919) 641.8246 • Email: npaclgaeCo.orange.n <br />NAME: 4+ ;+ 4. jg' j .VI I,trpI s <br />HOME ADDRESS; 'Z O 5 7re,IM DA t- U rC) f <br />CITY: C.v1A. (� zip Coda: Z 7 sl b <br />PHONE: (Day) "X4410 (Eveningnate) 1(2 *7 3 C $5 (Fax) <br />EMAIL: +i6k 1 o t @ Nay!oo • c-Onj Or L b u rns @co.dra.nge . ,7c. us <br />PLACE OF EMPLOYMENT: (yram�6 • A IDDdJOB TITLE: P1 r",e- Lt e *'r4/TJm in <br />&/" . <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP <br />OF RESIDENCE: <br />O Bingham O Cheeks O Hillsborough O Eno Chapel Hill 0 Little River O Cedar Grove <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />0 Joint Planning Aron 0 Extraterritorial Area O Transition Area <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSSIP OY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING QUESTIONS: O Male Female <br />ETHNIC BACKGROUND: 0 African Amarlcan.0 Caucasian 0 Hlspafrlc 0 NaMw American <br />0 Other DATE OF BIRTH: x- Is-- l 4 L 3 <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDSICOMMISSIONS ON WHICH YOU <br />WOULD BE WILLING TO NERVE. <br />7.1.VW1mrtSioin A/ Il)�►E�12. 3. <br />UV <br />WORK E7iPEFWMCE: (S,lzoea - u,re&A,t IB'u'+ae Co • <br />AM,. )u s J. 1-0 w /b' . ll 14, — S od Aun, c Nl , 1P Ma <br />w�ribp,r y s"erv%e 2 oWi. <br />S !Y! _ Q�t ror Gcc its / �rns•c.� <br />• s. <br />TPA" <br />r'o o p Lda./,ew _ b ; e <br />