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-_•~ <br />FOR OFFICE USE ONLY ~ I i I ~ ~~ ~ ~.- ~ ~ ~7 ~ <br />;. <br />,. .~~ ~e_ <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY 130ARDS 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 application and return to: <br />Orange County Commissioners' Office <br />P.O. Box 8181 <br />Hillsborough, NC 27278 <br />Phone (919) 732-8187; 688-7331; 968-4501; 227-2031 <br />Ext. 2125, 2129 or 2130 • Fax: (919) 644-0246 <br />NAME• ~1~'~`~~ ~~ f~'~~r <br />CITY: C.~~"p~ ~}'~~-~.' Zip Code: <br />suHNt ~~ <br />TELEPHONE: (H) ~`f9~J~'i ~ ~ I6 . 3'f7 gs3a (Fax) ~i~i ~~' <br />EMAIL: /t'Ln~ ~) Prop • d F•) <br />PLACE OF EMPLOYMENT: <br />JOB TITLE: ~- <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR <br />TOWNSHIP OF RESIDENCE: Bingham Cheeks <br />Hillsborough Eno <br />Chapel Hill 1~ Little River <br />Cedar Grove <br />IN ADDITION, PLEASE IyDiCATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />Joint Planning Area ~/ Extraterritorial Area Transition Area <br />WE ASK YOUR HELP IN ASSURING DNERSITY OF MEMBERSHIP BY AGE, GENDER <br />AND RACE, BY ANSWERING THE FOLLOWING QUESTIONS: <br />r Male ETHNIC BACKGROUND:• <br />Female 1/ African American Hispanic <br />Caucasian ri Other <br />Native American <br />DATE OF BIRTH: .3 rS 7 <br />PLEASE LIST ([N ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH <br />YOU WOULD B WILLIN TO SERVE. ~iy-d ~L • (o ~ ~ l~,y <br />1. <br />2. s <br />3. <br />