Orange County NC Website
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VOLUNTEER A.PP L I CAT I.ON <br /> OtRANGE COUNTY BOARDS AND COMMISSIONS <br /> If you are an Orange County resident , at least 18 years old, and killing to <br /> volunteer your time and expertise to your community, ple om lete and <br /> return to : [BOWIE <br /> 2 <br /> County Commissioners ' Office <br /> P. 0. Box 81811 3 1 <br /> Hillsborough, NC 27278 <br /> NAME: IAO�y ley MCA(h <br /> HOME ADDRESS : <br /> —Zip Code <br /> TELEPHONE: (W) 5(o --1-12-1 (H) 96--7 2-SLI <br /> PLACE OF EMPLOYMENT: Dca,'hnrtl CckAr)t:: Heco+'1 ►►'�=tr �'�fi <br /> JOB TITLE: <br /> ONT REVERSE SIDE LIST JOB, VOLUNTEER, AND EDUCATIONAL EXPERIENCE AND/OR SKILLS <br /> 3 WOULD LIKE FOR US TO CONSIDER. <br /> IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP OF <br /> RESIDENCE: <br /> Bingham Cheeks <br /> Hillsborough Eno <br /> Chapel Hill Little River <br /> Cedar Grove <br /> WE ASK YOUR'HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, <br /> BY ANSWERING THE FOLLOWING QUESTIONS: <br /> Male ETHNIC BACKGROUND: _ <br /> Female ✓ African American Hispanic <br /> 'Caucasian ✓ Other <br /> Native American <br /> DATE OF BIRTH.: <br /> 22 <br /> PLEASE PLEASE LIST ( IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU <br /> W BE WILLING TO SERVE. <br /> _`3°��ucnc.,r, _, 5_ <br /> c� (vt rtS <br /> �J a"► i�a C "rrrjTt'. <br /> CJ1 tY1 L'fV <br /> 4 . <br />