Orange County NC Website
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Iy,/.- <br />FOR OFFICE USE ONLY ' l~ <br />~• 1 a F 2 Barr. i e 1>~0-\~ ~';~ :'. 2 <br />~NL~1:1iNT-E~ER Ai'AtICAT~ION- <br />ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS <br /># ycni are a~ Orae{ge ir4t~fity tes{dent, at least 4 8 years olc#, arm ~rliling ~ ~r your time' ar~at <br />expertise to your community. please complete this application and return to; <br />w ails a~~_b• pd <br />flrar~e~ Cotfntll Bcrarc# of C~ntmlesioners' O#flce <br />P.O. Bax 8481 <br />rnught NG 27278 <br />Phone (919) 24x2125; 245-2129; 245-2130; 732 8181 <br />Fax: (9192644-0246 • Email: ncglavert~co.arange.nc.us <br />NAME: a a r ~C1 C.. ~ 0..~ 10. L-ti <br />i#3M~,A~~~R~E83:1~C7 ~t~5 C„~{ o ra. ~ ~';~y ~ _ y <br />C)TX: t43,1 ra ~~1 ~1p cot3®~- e~ 7c~•~ O <br />PHONE: (pay) ~ ~`~ _a 3 $1 (EveningJtate) ~E}`; ~ ~ S 1 (Fax) <br />F_AAAIL: ~' L. a ~' N ~' A ~, s ~ F PR.zt+ ~~tvlc N~.T <br />f+'tAGE-~ EIU1PtOa(~lllEd~T: 1Ja~ E ~ Q n.CoSel~ Jfl8 TiTt~E: ~C J <br />IAI DRDER TD dccttRF CDlI~ITYWIDEl~tEPRESENrATIOAIPLEASER~Ib1C~-TE YD1JF1: TOWb <br />OF RES~ENCE: <br />O 91n~ham O Cheeks ~ Hillsborough O Ena ^ Chapel HIII O Little Rh-er O Cedar Grove <br />IN ADDRION, PLEASE INDICATE IF Y LIVE IN ONE OF THE FOLLOWING AREAS: <br />O Joint PlanMng Area ~ Extrat vial Area O Transition Area <br />iplE~ Alf ~fT3UR'iiE~:P'iN'A DIVERSfTY OF #IiEiIABERSHIP BY AGE. GENi3ER AND RACE, <br />BY ANSWERING THE FOLLOWING QUESTIONS: D Mate ~1 Female <br />ETHNIC BACKGROLND: O African AmeHcan ICJ Caucasian O Hlspadc II NatMe AAlerlcan <br />U Other DATE OF BIRTH:.1~s3Q(Sr 1 <br />PLEASE ii8T (HV ORDER OF PREFERENCES THE BOARDS/COMINI6SIONS ONI WHICH YOU <br />WOULD BE WILLING TO SERVE.. . <br />1. ]'fi il~bb~rx b-h f IGnn inG bArrfd 2. H1 t t~Ol~-1 ~d~ _[~q,}~MUy, 3. <br />adIORK f 7CPF_RiFJ+ICE: <br />VOL'if1~iTEER~7CPERiENCE: <br />d-b,/ a~~ <br />~G cG : cif <br />ada'~ `~ ~~ ~~ <br />