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32 <br /> VOLUNTEER APPLICATION <br /> ORANGE COUNTY BICYCLE TASK FORCE <br /> S P C tiOn iS public dociiimei it <br /> If you are at least 18 years old, and willing to volunteer your time and xpertise to the Orange County <br /> Bicycle Safety Task Force,you may complete this application and mall/email it by March,41_, 2016 to the <br /> address/email below: <br /> Orange United Transportation Board <br /> (OUTBoard) <br /> c/o Abigail° Pittman, Planning Department <br /> P.O. Box 8181 <br /> Hillsborough,NC 27278 <br /> Phone(919)245-2567 <br /> Email:abpittmart@pran,ecountync.gov <br /> Your application will be considered by the Commissioners when reviewing and making appointment& <br /> peter h. klopfer <br /> NAME: 111111111111.11111111111111".11.111111111111111 <br /> HOME ADDRESS:4801 friends school rd. <br /> CITY: LiY: d rham (orange county)' 27705 <br /> Zip Code: <br /> 919 393 3237 ibid <br /> PHONE: (Day) (Evening/late) (Cell) <br /> EMAIL: phk@duke.edu <br /> duke universtiy professor em. <br /> PLACE OF EMPLOYMENT: JOB TITLE: <br /> ARE YOU AT LEAST 18 YEARS OF AGE? <br /> Yes No 0 <br /> ARE YOU A MEMBER OF ANY OF THE FOLLOWING GROUPS?(Check all that apply) <br /> RLaw enforcement agency El Orange County business Hillsborough/Orange <br /> School representative 0 Bicycle advocacy group Chamber of Commerce <br /> Orange County Visitors Bureau Orange County Planning Ej Chapel I lill/Carrboro <br /> NCDOT Department staff Chamber of Commerce <br /> ri Group working with drivers education r- Regional planning staff <br /> classes and/or traffic offenders <br /> PLEASE LIST YOUR CURRENT COMMUNITY ACTIVITIES/ORGANIZATIONAL MEMBERSHIPS: <br /> trustee, carolina friends school <br /> delegate, american friends service cornmittet <br /> state representative, friends committee on national legislation <br />