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16 <br />Page 1 of 1 <br />Tod Puckett <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 />Township of Residence: <br />Zone of Residence: <br />Sex: <br />Ethnic Background <br />Mr Tod Puckett <br />115 Fellowship Lane <br />Rougemont NC 27572 <br />919- 245 -1968 <br />919- 245 -1968 <br />n/a <br />puckett.tod @gmail.com <br />Retired <br />Retired <br />2014 <br />Little River <br />Female <br />Caucasian <br />Community Activities /Organizational Memberships: <br />Lay Leader - New Bethel UMC <br />Boy Scouts of America <br />Past Service on Orange County Advisory Boards: <br />none <br />Boards /Commissions applied for: <br />Human Relations Commission <br />Background, education and experience relevant to this board: <br />Career Military, the most diverse environment you can find. Graduate of NCCU as minority <br />student <br />Reasons for wanting to serve on this board: <br />To help ensure Orange County is being as fair as possible to it s citizens and employees. <br />Conflict of Interest: <br />Supplemental Questions: <br />Other Comments: <br />This application was current on: 1/21/2015 10:45:20 PM Date Printed: 1/23/2015 <br />