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FUR OFFSCE USE ONLY <br />i~/o2-._ Paq e / of Z 12cibert ~ daaile <br />VOLUNTEER APPLICATION <br />pRANGE COUNTY ADVISORY BOARDS AND COMMISSIONS <br />If you are an Orange County resident, at least 18 years old, and willing to volunteer your time and <br />expertise to your community, please complete this application and ret <br />Orange County Commissioners' Office D ~ ~ ~ v <br />P.O. Box 8181 <br />Hillsborough, NC 27278 MAY i 42002 <br />Phone (919) 245-2125; 245-2129; 245.2130; 732 <br />Fax: (819) 644A246 • Email: nmartin@co.oran . <br />NAME: f2088$$' € Bi4~LSY ___._ <br />HOME ADDRESS: 6015 DEERWOOD LANE <br />( ORANGE COUNTY) <br />CITY:_;_,-~ DiZRH~. N. r. _~ Zip Code: 27705 <br />PHONE: (Day) 919 383 669 (Eveningliate) FAMWF ,_(FaX) <br />EMAIL: NONE <br />PLACE OF EMPLOYMENT: RETIRED _~~_,,,_JOB TITLE: <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP <br />OF RESIDENCE: <br />^ Bingham ^ Cheeks ^ Hillsborough ~Ci Eno ^ Chapel Hiil ^ Little River ^ Cedar Grove <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />}~ Joint Planning Area ^ Extraterritorial Area ^ Transition Area <br />WE ASK YOUR HELP IN ASSURING DNERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING QUESTIONS: ~[dMale ^ Female <br />ETHNIC BACKGROUND: ^ African American Caucasian ^ Hispanic ^ Native American <br />^Other DATE OF BIRTH: __6/23/30 <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDSlCpryIMISSIONS ON WHICH YOU <br />WOULO BE WILLING TO SERVE. <br />1. _ ABC CONTRb ~, ~EAAt(SF ATl nF nnTTTCmMT:nl~. PF.RSf1NRT.T. AT)VTAORY BOA' <br />WORK EXPERIENCE: rFamrr.'rFT, nUAIIC I1CC98~i`~AALT SF~PiS£ ~9Cg:'. ------.-. <br />PARTNER AND PRrN 'rPAT,, IH FTRMR 4TN('F ],Q79 __ <br />ASSOCIATE NEAL BRADSHE$_AND TAYT,OR SrNrF ~qoq _ <br />VOLUNTEER EXPERIENCE: TREASURER ST PHILIPS EPZSCOPAL CHURCH <br />