Agenda - 06-03-2003 - 9-e-4 - Laserfiche WebLink

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8 FOR OFFICE USE ONLY ~ o l= S Garyc~ ~~~~~Ll(' ~i 1 r'; ; ' oec i o aooe I' ,, . VOLUNTEER APPLICATION ORANGE COUNTY ADVISORY BOARDS AND COMIiAISSIONS If you are an Orange County resident, at least 1 B years old, and willing to vol expertise to your community, please complete this appiicatian and. return to: NAME: HOME ADDRESS: „~ r1 ,2_F~ R. S ~1 t~ ,1~ /~ ~~~~ ,_„ CITY• ~ •/,~ /~ r 1 ,~~. L ~ Zip Code•...~Z.._ PHONE: (Day) p~ 7- , ~' [7 q/ (Eveniny/late) ~(`~• , S^n 8 f (Fax) /y ~~ EMAIL: ,~~~~_ r. r .2 ~ f~ /? TH ~/~_ ~(~ 7- PLACE OF EMPLOYMENT: f ~ ~~ r ~. m~_JOB TITLE: ; ~,f c ~~,,tit12~~ IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR 70WNSHIP OF RESIDENCE: O Bingham O Cheeks ~ Hillsborough O F~to (]~ Chapel Hill O Little River O Cedar Grovs !N ADDITION, PLEASE INDICATE IF YOU LIVE iN ONE OF THE FOLLOWING AREAS: C7 Joint Planning Area O Extraterritorial Area ~ Transition Area WE ASK YOUR HELP IN ASSURING DNER5ITY OF 11~EMBERSHIP BY AGE, GENDER AND RACE, BY ANSWERING THE FOLLOWING QUESTIONS:. (~ Male O Female ETHNIC BACKGROUND: O African American Q~Caucasian O Hispanic O Native American O Other DATE OF BIRTH: j~ - ?. ? -, i 2 PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU WOULD BE WILLING TO SERVE. ~ F i n ~ !?~~ F 1~ n iC! na .. n ~a is n %~.•,,r~~i /Ts ~a rie.v 1 1. t~1y i. s ~.vlr' n n yi r~.o r 2. ~ .v 17 ~~~sr~r 3. ~ n .ri ~» i { r : e nr WORK EXPERIENCE: VOLUNTEER EXPERIENCE: , ~,~ ~,~'~' t,~r» ,~ ____~ Orange County Commissioners' Office P.O. Box 8161 Hillsborough, NC 27278 Phone (919) 245.2125; 245-2129; 245-2130; 732-8181 Fax: (919) 644.OZ46 Email: npaciga@co.orange.ne.us Sc q,clc. _ .~_ 1 k a.~.dY / db/ . c~ drifs' .