Agenda - 04-16-1997 - 8a - Laserfiche WebLink

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VOLUNTEER APPLICATION ORANGE COUNTY BOARDS AND COMMISSIONS If you are an Orange County resident, at least 18 years old, and willing to volunteer your time and expertise to your community, please complete and return to : County Commissioners ' Office P. 0. Box 8181 Hillsborough, NC 27278 NAME: HOME ADDRESS : R1V4Ir Orctn dr-r r'aYr— �cL NC•-- Zip Code ZZZ7ef- TELEPHONE: (W) 7.r D —9�7%�3 PLACE OF EMPLOYMENT: //�� , JOB TITLE: Own er Q 1� ON REVERSE SIDE LIST JOB, VOLUNTEER, AND EDUCATIONAL EXPERIENCE AND/OR SKILLS YOU WOULD LIKE FOR US TO CONSIDER. IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP OF RESIDENCE: ` Bingham Cheeks Hillsborough Eno Chapel Hill Little River Cedar Grove WE ASK YOUR•HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, BY ANSWERING THE FOLLOWING QUESTIONS: Male ETHNIC BACKGROUND: Female African American Hispanic Caucasian _ .i Other Native American DATE OF BIRTH: PLEASE LIST ( IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU WOULD BE WILLING TO SERVE. 2 . _ 4 .