Agenda - 01-31-2012 - 4 - Laserfiche WebLink

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7 Town ETJ Trans.Area TOWN OF CARRBORO .~..~ Application for Membership on Advisory-Board ~ ~~ ~-- NAME: ADDRESS: DATE: IS THIS ADDRESS LOCATED WITHIN THE CORPORATE LIMITS OF THE TOWN OF CARRBORO? TELEPHONE:[HOME] _ [BUSINESS] _ DATE OF BIRTH: _ E-MAIL ADDRESS: RACE: SEX: LENGTH OF RESIDENCE IN ORANGE COUNTY: OCCUPATION: ARE YOU A REGISTERED ORANGE COUNTY VOTER? TOWN OF CARRBORO: COMMUNITY ACTIVITIES/ORGANIZATIONAL MEMBERSHIPS: I wish to be considered for appointment to the following advisory board(s): ^ Board of Adjustment ^ Northern Transition Area Advisory Com. ^ Appearance Commission/NPDC ^ OWASA Board of Directors ^ Arts Committee ^ Orange County Economic Dev. Com. ^ Economic Sustainability Commission ^ Orange County Human Relations Com. ^ Environmental Advisory Board ^ Personnel Advisory Committee ^ Greenways Commission ^ Planning Board ^ Human Services Commission ^ Recreation & Parks Commission ^ Transportation Advisory Board ^ Other If you apply for membership on more than one advisory board, please indicate your preference by number, with "1" being your first choice (please limit your selection to two (2) boards). Please note that membership is limited to one advisory board at a time. You shall not be considered for appointment to another board unless you resign before filing an application or you are in the last six months of your current term. EXPERIENCE TO AID YOU IN WORKING ON THESE ADVISORY BOARDS: REASON(S~ YOU WISH TO BE APPOINTED: HAVE YOU EVER SERVED ON ANY TOWN OF CARRBORO ADVISORY BOARD? IF "YES", WHICH ONE(S~ RETURN THIS FORM TO: TOWN CLERK, 301 WEST MAIN STREET, CARRBORO, N. C. 27510 www.townofcarrboro.or~ (Please note that this document and the information contained on it is a public record and must be provided by the town to anyone requesting a copy of i~)