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f~~ <br />FOR OFFICE USE ONLQY ~ ^,,~ ` ~ j <br />• ` ~ ~ 2 ' ` i ~.-~7. Gt 1 ~'i.`~ ~O~ CHIC SOi9 <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS <br />If you are an Orange County resident, at least 18 years old, and willing to volu <br />tr expertise to your community, please complete this application and return to: <br />K4~2 ' ~~)'w'S ~S Orange County Commissioners' Office <br />t ~ ~I`7a.I1 P.O. Box 8181 <br />Hillsborough, NC 27278 <br />CpU. Phone (919) 245-2725; 245-2129; 245.2130; 732-6181 <br />Fax: (919) 644-0246 • Email: ncglover~co.orange.nc.us <br />- ., <br />NAME: <br />HOME ADDRESS: 1~~~C~ U~ ~Y ~D W ~ST _.,'~' I~_ _ _. . . <br />. ~- -- <br />CITY• U !-~A'1'1(~ C ~ n @~ip~Code:_ a?770,rj <br />PHONE: (Day)ot8(p ~'~3c.y (Evening/late) - J (Fax) ~ ~ ~--~"~'•3~'~ <br />EMAIL: Q~~~~ t`. j) (rYl <br />PLACE OF EMPLO MENT:_ 1laTaQ~ ~ P~'oU~C•dOB TITLE: o-t~-~~ y.Q, J~$S'f~A~~ <br />IN ORDER TO ASS~E CO~NTY~V)lls REPRESENTATIO PLEASE INDICATE YOU OWNSHIP <br />OF RESIDENCE: ~ ~ ~p CIO'a~~ GT~iv~~'~i~ ~~c~ <br />^Bingham OChee .^Hillsborough ^ Eno OChapel Hili OLittie River ^Cedar Grove <br />1-~r+cd" ~~ea~ ~+~i~-t~t"~ - au~ <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS• <br />^Joint Planning Area ^Extraterritorial Area ^Transition Area ~rH y+4~~-P~ <br />5 <br />WE ASK YOUR HELP IN ASSURING DNERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING QUESTIONS: ^Male }female <br />ETHNIC BACKGROUND: DAfrican American ^Caucasian Hispani ^ ative American <br />^Other DATE OF BIRTH: <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDSICOMMISSIONS ON WHICH YOU <br />- -~ - - ~- WORLD BE W1111NG TO SERVE:.. -... _.._ _.. ._- . .-- -- ... .. _.. <br />''tt~ <br />1. i-x~rraN ~La,-~ ~~~~~~~~-ti;; ~r'.~2.,t~ ~. Drne,~, M~3 ~ . rnan ~r Asa r y <br />~xa~o~e~r-el1~.d..~ /'~..~ .._r /nn~ ..~L ~ _~ .. 1; - - ' 1 . _ 1 .. ~ .~!n~l~'r` , <br /> <br />~ ~ ~ ~~~ ~ <br />f A ~~ S Jr~~ i r 6~`- a i ceo <br />E~ NGr: ~1fe • ~Sfarlvf ~I'_ ('L~vl~.n hD~~- w~......o.~'s7 <br />• C . ~~ /- lTV-V'X-L.,Q.~ ILJnw~Pu e n ~ .. _ ~, d cGn. <br />~d <br />e <br />