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<br />/4 <br />FOR•OFFICE USE ONLY <br />8/ IS/99 - of 2 5a~ne~- Chan~nar~ <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY BOARDS AND COMMISSIONS <br />If you are an Orange County resident, at least 18 years old, and willing to volunteer your <br />time and expertise to your community, please complete this appiicati _ ~ ~ rn to` `~ <br />Orange County Commissioners' Office <br />P.O. Box $181 <br />Hillsborough, NC 27278 <br />Phone (919) 732-8181; 688-7331; 968-4501; 227 <br />-Ext. 2125, 2129 or 2130 • Fax: (919) 644-0246 <br />HOME A,ADDRESS: ~ t~ /d, w h- d -~ t~~~! fo n r~r,~,,,~ <br />CITY:.1~ i ~ - Zip Codez~ 7 d..7 <br />TELEPHONE: (H~'~~„~Z~.~.~770~~ Fax) <br />EMAIL: <br />PLACE OF EMPLOYMEN'IC~~ .~ .[? ~ JOB <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR . <br />TOWNSHIP OF RESIDENCE: Bingham Cheeks <br />Hillsborough '~ Eno <br />Chapel Hill Little River <br />Cedar Grove <br />IN ADDITION, PLEASE.INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />Joint Planning Area Extraterritorial Area Transition Area <br />WE AS1C YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER <br />AND RACE, BY ANSWERING THE FOLLOWING QUESTIONS: <br />Male ETHNIC BACKGRQUND:- <br />Female ~ African American <br />Caucasian <br />~ N~at~ive American <br />DATE OF BIRTH: ~~'-- ~4y--• <br />Hispanic <br />Other <br />PLEASE LIST (IN ORDER OF PREFE NCE) THE <br />YOU W UL E LLING 5 RVE.~ a! <br />1. <br />2, ~,p~q~ar~ a.nd t~ICS of SoR <br />:OMMISSIONS ON WHICH <br />(~wNry P,C,an,~1r[g 8o~a..-d <br />