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I ._~ ??~aa 9197324524 <br />' _3:t3a Buck TredwOy <br />AYR MOUNT <br />7~ <br />P'~~2 di ! ~ Crowther <br />VOLUNtEER APPLICATION <br />ORAN06 COUNTY BOARDS AND COMMISSIONS <br />If you are an Oranoa County realdsnt, at feast 18 yeses eld, and wiillne to votunNer your time •nd <br />exprrttse to your community, plsa~a apmp(ste xnd return to: <br />OrartQ~ COUMy C4menis~ioners' Oflica <br />P. o. Box ata~ <br />Milisiwnwgh, NC z727a <br />Na(aE: .~.~~~ HER ~ <br />MomE AooRESS: .,.,._3~ ~. St. Vl~t 1RRy5 R.0 <br />Kl~t,5Q01~o~~9,N__ zip ~ee.~_ <br />~ ~ c~ ~ uv ~ ,~,~:t; <br />~I I <br />1~. <br />MAtt I 11999 ~ { Jt <br />tEI.EpHONlE: tKf '1~7~•jS37 tWy__ 3z_688, ~ ~F,xy 73`I„~...._ <br />EMAIL <br />RLACE OF EIifPLOYMENT: Rye ~lDU1JT <br />Joe TITHE; S cTtG Ihl f~ ~ . <br />-- r._~..... <br />1 LIST dOQ~ vOWNTEER, ANO EDUCATIONAL EXPEAttENCE ANDlQR Sit(LLS Yl~U <br />t,.Cf S TO CONSIDER. <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR tOWNSHIP OF <br />RESIDENCE: B(ngi'iam ~ CheNcs <br />Mlilsborouph ,~., Cnv ,,,,~_,_,~ <br />Chapel HIII _,"_„~ LiKle River ~~ <br />Csdat Grow <br />IN AdOmoN, PLEASE INWCATE 1F YOU LfVE IN ONE OF THE FOLLOWiNO AREAS: <br />JPA (Joint Planing Ar+wa~ <br />EA tlactraterrlWrial Arse) <br />TA f?rartsltioes Array ~,,,,,.,~ <br />WE AsK YOVR HELP IN ASSURING DIVERSITY OF MEM6ERSHlR 8Y AGE. GENDER AND RAtE, BY <br />ANSWERING THE FOLI.OrII1N6 Ql1ESTIONS: <br />date _,. X ,_. <br />Ftmule ~___,_ <br />DATE OF BIRTH <br />-- te13e1s3 <br />ETHNIC BACKGROUND: <br />African American _„„~,_ <br />Cauwsfae _~ <br />Native Amerlptn ",~„ <br />H(spae~k <br />Other `~ <br />PLEASE LISP (IN ORDER OF PREFERCNG~ THE 9Q/IROSICOIMMIS3l~IS ON WHICH YOU WOULD <br />BE WILLING TO SERVi:. - <br />~. E.~ R ii: 12-I~-o- <br />Z. G or ~s~e~clt e, ,da'~ IL- ~ i ' a <br />3. <br />R~n~,e~ on i2~~iw 5~a3jo3 ~~u~~D -ra B~ Nlo~~.u <br />r2oM ~4LT~~¢~T~` -~Fd '~~~Ut~tz `'vv~ <br />