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HrR i'4 2003 12:41PM ORRPIGE COUNTY HOCC (9191 644-0246 <br />FOR OFFICE USE O~~Y <br />p. t o ~ 2 ~~. ~~5 i~uwl~as <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS <br />If you are all Orange County resident, at least 78 years old, and willing to volunteer your time and <br />expertise to your coimmunity, please complete this application and return fo: <br />Orange County Board of Commissioners' Ofifce <br />P.O. Box 8181 <br />Hillsborough, NC 27278 <br />PI-dne (919) 245.2123; 245.2129; 245.2138; 732.8181 <br />Fax: (919) B~4G246 -Email: ncglover~co.orange.nc.us <br />NAME: ~a Arclf ,LE w j ~ ~~ t~•~lciN s- <br />HOME AODRE$S:.,•,.L srf .S ~ ~'f 8 t'`'k~ L' a ~H'1` - _.,._._______ ~ ~ ~.._. <br />GITY• _.~ ~ ~ h ~Jro4,~' r /V C-- ~______ Zip Coda: ~~ <br />T' <br />PHONE: (Day) 919-73~ •~ (Eveningnate) S ~~~ _ (F~) _.. <br />EMAIL: ~~ awkLu ~ r~i iNd sp~i ~ ~c+~~ <br />PLACE OF EMPLOYMENT: 's ~ v :•cr~c _~ JOB TITLL'• SJoYI Gt i ~~ <br />'7 <br />-6~ ~i <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP <br />OF RESIDENCE: <br />O Bingham O Chocks ©Hillcborough O Eno D Chapel Hill 4 Little Rlver~CSdar Grove <br />• IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />O Joint Planning Area O Extraterritorial Area D Tran9ition Area <br />WE A8K YOUR HELP IN ASSURING ONERSC[Y OF EMBERSHIP BY AGE, GENDER AND RACE. <br />BYANSWERINt3 THE FOLLOWING QUESTION Male O Female <br />ETHNIC BACKGROUND: O Afrlean Amerlean~Q Caucasian O Hispanic D Native American <br />O Other DATE OF BIRTH: <br />PLEASE LIST pN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU <br />WOULD BE WILLING TO SERVE. <br />1. ~S._.SSe...Z.~G .. . , _...... ---2. M .... _..~ . ... - _ 3. ._ - ._ _ -- _,__ <br />WORK EXPERlENC1a: <br />NTEER EXPRRIENCE: ~` V P L ~M^ ~~~~. ~s-r ~7`8w C~v1s <br />nllQArS`6N^~6FL' C/ <br />~b~.,-~ <br />EECEIVED 04-24-'A4 ~7•c~ rnnM _-- <br />/~ <br />