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9 <br />Page 1 of 2 <br />Sam Lasris <br />Volunteer Application <br />Orange County Advisory Boards and Commissions <br />Name: <br />Name Called: <br />Home Address: <br />Phone (Day): <br />Phone (Evening) <br />Phone (Cell): <br />Email: <br />Place of Employment <br />Job Title: <br />Year of OC Residence: <br />Dr. Sam Lasris <br />7020 Caviness Jordan Rd. <br />Cedar Grove NC 27231 <br />919- 732 -7362 <br />919- 732 -7362 <br />samlasris@hotmail.com <br />Self Employed <br />Dentist <br />1977 <br />Township of Residence: Cedar Grove <br />Zone of Residence: Cedar Grove Twnsp <br />Sex: Male <br />Ethnic Background: Caucasian <br />Community Activities /Organizational Memberships: <br />Volunteer for the Intenational Affairs Council of North Carolina, RDU Airport and the <br />OUTBoard. <br />Past Service on Orange County Advisory Boards: <br />OUTBoard and Planning Board, past member <br />Boards /Commissions applied for: <br />Board of Health <br />Background, education and experience relevant to this board: <br />I have been a dentist since 1975, beginning in public health. I have accepted medicaid patients <br />from Va throughout my career and NC medicaid patients as well. I would bring to the board first <br />hand knowledge of the needs of the diverse population of Orange county and could serve as a <br />liaison between the OUTBoard and the Board of Health. <br />Reasons for wanting to serve on this board: <br />Conflict of Interest: <br />Supplemental Questions: <br />Other Comments: <br />STAFF COMMENTS: APPLIED FOR BOARD OF HEALTH 10/4/2013. Applicant since <br />2000. Renewed application 10/02/01 for Recreation Parks, Economic Development, and <br />Arts Commission. Renewed application for Planning Board on 03/08/02. Reapplied <br />10/19/2005 for OUT Board. Renewed application 10/26/2012 for OUT Board. ADDRESS <br />VERIFICATION: 7020 Caviness Jordan Rd., Cedar Grove, NC is Cedar Grove Township, <br />