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RESUME' <br /> Name: _.._ �� ..�/ ��c• rlt�/ i °� - <br /> Mailing Address: <br /> 4�Jcs if z:?Z,- zip Code ��C1 <br /> Telephone: as-"I"Home `aS,3 -�,!Z-?�usiness <br /> Ethnic Background: Black .T Indian White other <br /> Sex: :Male Female Age: <br /> Education: (Highest) _ <br /> Occupation: -- <br /> Community Interests and Activities: <br /> What segment of county or population would you represent <br /> (Not applicable in some instances) <br /> I am interested' in serving on: <br /> Date: d �,� Signature <br /> C <br />