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~• I o~2 <br />ita. (ron~~1 es-' <br />FOR OFFICE USE ONLY <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS ' ~ n <br />If you are an Orange County resident, at least 18 years old, and willing to volun ~ ~r~~l <br />expertise to your community, please complete this application and return to: <br />c~ SS IS Orange County Commissioners' Office <br />I ~ ~ P.O. Box 8181 __ .. . <br />f"?~I7 Hillsborough, NC 27278 <br />(;ou Phone (919) 245-2125; 245-2129; 245.2130; 732-8181 `~ ~"` <br />Fax: (919) 644-0246 • Email: ncglover~co.orange.nc.us <br />NAME: <br />HOME ADDRESS: l~~~C~ (~~ .~,1)~ 7~ (IIJ~r ,'~' J~ <br />.. . _ .... _ - - _ .... .'T- - - -- -- . . <br />CITY: <br />PHONE: (Day) G~GM --~I ~(~ (Evening/late) <br />EMAIL: <br />~7 ~t7~ <br />~ u7K o X8b- 730' <br />PLACE OF EMPLO MENT:_ 1~~ ~ PTOUSC.dOB TITLE: n~~-~i~ y.(, }qS5'/,S~IkT <br />IN ORDER TO A55 E OUNT,YV~IID REPRESENTATIO PLEASE INDICATE YOU I3 OWNSHIP <br />OF RESIDENCE: ~~~EI-~,1'~`ts -~i1p ~ C/052-7+(0 ~~f,~~Ct~~~is~'"~a~~ <br />OBingham ^Cheek .^Hillsborough ^ Eno ^Chapel Hili ^Littie River ^Cedar Grove '~'I <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS• G_ <br />^Joint Planning Area ^Extraterritorial Area DTransition Area ~m y'C~SZ-tai -~ <br />IMO6l./Z.S <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING QUESTIONS: ^Male emale <br />ETHNIC BACKGROUND: DAfrican American OCaucastan Hispani ^ ative American <br />^Other DATE OF BIRTH: <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDSICOMMISSIONS ON WHICH YOU <br />- -~ - ~ ~ - WOULD BE WILLING TO SERVE:.. .... _ .._. _.. ._.. ... -. ..... _ .. <br />~D`,„[Y' <br />~~. <br />CtFrle~v--U.~m~.rrecc,~-~~-r-trha ~rrl~arnc~nn ~/~ <br />._.~ ~.~i. a..i I/! .. /~_~.n.,......~.i YA~!'i it ~.n w..i ~wJ/~/Sf/..~~/ <br />