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9 <br />~ ~ ~'~ CITY OF DURHAM, NORTH CAROLINA <br />- Board, Commissions, and Committees Application <br />Office of the City Clerk <br />101 City Hall Plaza • Durham, NC 27701 <br />Phone Number: (919) 560-4166 <br />~ ~ ~ ~ Fax Number: (919) 560-4835 <br />~- ~ ~ = Website: www.durhamnc.gov <br />- Please complete this application in its entirety <br />- Only applications with signature will be accepted <br />- Complete one application per Board/Comxnission/Committee <br />- Return application to above address via USPS or Fax <br />- Hours of Operation: 8:00 a.m. - 4:30 p.m. Monday through Friday <br />- Property Tax Listing must be current. City and County Taxes must not reflect any delinquencies <br />- Application will be released to the public upon request <br />Application is active at the time of vacancy only <br />ETHNIC BACKGROUND <br />ARE YOU AT LEAST 18 YEARS OF AGE? ^ YES ^ NO <br />SEX: ^ MALE ^ FEMALE <br />^ Audit Services Oversight Committee ^ Durham Cultural Advisory Board ^ Homeless Services Advisory Committee <br />^ Capital Program Advisory Committee ^ Durham Housing Authority ^ Housing Appeals Boazd <br />^ Citizens Advisory Committee ^ Durham Open Space & Trails Commission ^ Human Relations Commission <br />^ Convention & Visitors Bureau Board of Directors ^ DPAC Oversight Committee ^ Lyon Park Advisory Board <br />^ Design District Review Team ^ Durham Plannin Commission <br />g <br />^ Passenger Vehicle For Hire Commission <br />^ Durhazn Bicycle and Pedestrian Advisory Commission ^ Environmental Affairs Board ^Ra1eigh-Durham Airport Authority <br />^ Durham Board of Adjustment ^ EBOP Advisory Committee ^ Recreation Advisory Commission <br />^ Durham City-County Appearance Commission ^ Firefighter's Relief Fund Board of Trustees ^ Triangle Transit Authority <br />^ Durham Convention Center Authority ^ Historic Preservation Commission ^ Workforce Development Boazd <br />Do you live within the Corporate City Limits? ^ YES ^ NO <br />Name of any City of Durham Board/Commission/Committee that you are serving on at the present time Date Term Expires <br />NAME <br />HOME <br />Business <br />SPOUSE NAME <br />Street City State Zip Code Home Phone <br />Place of Business Email Address Occupation <br />Street City State Zip Code Business Phone <br />