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/$ <br />FOF OFFICE USE ONLY ,Q <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS . ' <br />fE you,are an Orange County resident, at least 18 years old, and willing to <br />expertise to~your community, please complete this application and return <br />Orange County Commissioners' Office ~, 2 ~ 2~ <br />P.O. Box 8181 <br />Hillsborough, NC 27278 <br />Phone (919) 245.2125; 245-2129; 245-2130; 732-8181 <br />Fax: (9191) 6440246 • Email: npaciga@co.orange.n <br />NAME: ~~f 1 r\St,~~ ~0 0.~' 1 - <br />HOME ADDRESS: ~O ~,_ , ~ P '(~ m O Ce ~ ~?`- -- <br />CITY: Zip Code: ~~ Jc~ ~ <br />PHONE: (Day) ~, <br />(Q\~ ~ S~~- y~a <br />EMAIL: v n <br />(Evening/late) SOfY~-' (Fax) <br />PLACE OF EMPLOYMENT: r ~rf R~ ~ ' - o ~~ JOB TITLE: <br />~~•^``~ <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATtOr+l PLEASE INDICATE YOUR TOWNSHIP <br />OF RESIDENCE: <br />O Bingham ~ Cheeks O Hillsborough O Eno C~(Chapel Hill O Lithe River O Cedar~Grove <br />IN ADDITION, PLEASE'INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />O Joint Planning Area ~ F-xtf'atem~to~rfal Area O Transition Area <br />WE ASK YOUR HELP IN ASSURING DNERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING QUESTIONS: O Male C9:Female ' <br />ETHNIC BACKGROUND: O African American QlCaucaslan O Hispanic American <br />O Other DATE OF BIRTH: ~ 'L 1 <br />PLEASE UST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU <br />WOULD BE WILLING TO SERVE. <br />1, sy Nnrh ~ ss i y~-~q /' <br />~ o r ~'"r <br />WORK EXPERIENCE: _~ <br />"moo o.~J~ <br />voLUNTEER i~cP~wENCE: s.~ a~ a ~~•.~ ~. r ~ s ~.y~_ <br />