Orange County NC Website
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/'} <br />FOR OFFICE USE 4KlY <br />$ 5 9 q P- I o f 2 Rose++ci, loci sh <br />VOLUNTEER APPLICATION <br />ORANGE GOUNTY BOARDS AND COMI IIiSS10NS <br />If you an an Orange County resident, at feast 18 years oht, aed waling . volunteer your <br />thns and axpertiae to your community. please complete thh = appliesdon <br />Orange County Commh~sioaers' Offlcs <br />P.O. sox 81E1 '~ 2 5 x999 <br />Hilh;bor~ough, NC 2TZ78 <br />Phorre (91S} 732.8184; 688-7331; $Ba-it~01; 227-ZO <br />Ext. 2725, 2129J_vr 2130 • Fax (918j 64-0246 <br />NAME: !S oSP~~(fl ~ASO <br />i r~ <br />\ HoN1E ADDRESS: 110 ~llr~f,~~cac~ <br />. G~• _ FLlL~ bolo d~lh Alertl ~ ~rn~i Zip Code: ~ 7.'17 ~ <br />TELEPHONE: (H} _(a ~f ~. -!~~,~.~ (W} ~~7 ~ o~o~l~ _ -- {Fax) ,~~ 7-fit p l ~ <br />EMAIL: <br />PLACE OF EMPLOYMENT: !FC o ~ JOB Ti 1'LE: ~~rat,~ ~ Vi r~[ ~r <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION i'LEASE INDICATE YOUR <br />TOWNSHIP OF RESIDENCE: gingham Cheeks .______ <br />Hlllsboeouph x Eno <br />._._.~ <br />Chapel HIII . Lfttls Rh-er <br />---~--_ <br />Cedar Grove <br />!N ADDITION, PLEASE INDICATE IF YOU L1YE IN ONE OF Tl tE FOLLOWING AREAS: <br />JolrK Piattntnp Area Extraterritorial Area Trans itton Acmt <br />WE ASK YOUR HELP iN ASSURING DIVERSITY OF MEAIBERSHiP BY AGE, GENDER <br />AND RAGE, BY ANSWERING THE FOLLOWING QUE5YION4 ~: <br />Mats . ~ ETHNIC BACKGROUND:- . <br />Fdenale x Afrhan American ~,~ Hhsp~nie <br />Caue~-siael Other __„ <br />Nathre Atneric~n ~ - <br />OATS OF BIRTH: _ ~- t S ~ 2 <br />PLEASE UST (IN ORDER OF PREFERENCE) THE~ARC SfCOMMISSIONS ON WHICH <br />YOU WOULD 8E WILLING TO SERVE ~n,~e~ d 4 6 <br />1. ~L r .&~~LdS/ Ca~n~~sS~ ozo ,t~c,~ <br />2. - - - ~ WaJ ~ ils,/a <br />3. r~ ~ ~,a,t'-3 v <br />G ~. <br />/y-arr~[ fry <br />p~.~~2c,,.o-~~ <br />