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~~ <br />12/19/00 <br />This space for office use only <br />Page 1 of 2 <br />Sam Lasris <br />VOLUNTEER APPLICATION <br />ORANG:IE COUNTY BOARDS AND COMMISSIONS <br />If you are an Orange County •esident, at least 18 years old, and willing to volunteer your time and <br />expertise to your community, please complete this application and return to: <br />Oran i,~e County Commissioners' Office <br />P.O. IBox 8181 <br />Hillsl,~orough, NC 27278 <br />Phon ~ (919) 732-8181; 688-7331; 968-4501; 227-2031 <br />Ext.:!:125, 2129 or 2130 -Fax: (919644-0246) <br />NAME: -----._-----------------. -•- Sam Lasris <br />HOME ADDRESS: -----•--------- 7020 Caviness Jordan Rd. <br />CITY: ---------»~_------____-_-_-- Cedar Grove <br />STATE: ---------------------------- NC <br />ZIP CODE: ------_--------------.-- 27231 <br />TELEPHONE: (Horne) ------------- 732 7362 <br />TELEPHONE: (Work) -----------~ -- 804 797 2357 <br />TELEPHONE: (FAX) ----------..--- <br />EMAIL. ---------------~_----__... samlasris@hotmail.com <br />PLACE OF EMPLOYMENT: --___ 395 S. Main St. Danville VA <br />JO$ TTTLE: ----_-_____-~_____._ Self-Employed General Dentist <br />TOWNSHIP OF RESIDENCE: ---- Cedar Grove <br />ZONE OF RESIDENCE: ---------- - <br />SEX: ----------------------------- -- Male <br />ETHNIC BACKGROUND: --------- Caucasian <br />DATE OF BIRTH: ---------------• --- 121149 <br />LIST, IN PREFERENCE, THE B OARDSlCOMMISSIONS ON WHICH YOU WOULD BE WILLING <br />TO SERVE: <br />1: ------------------••-- C-range County Planning Board <br />2. --------------------- <br />3. --------------------- <br />Please work, volunteer, and ed icational experience. <br />WORK EXPERIENCE: Self Ilmployed Dentist for 24 yrs <br />VOLUNTEER EXPERIENCE I have served on various committees throughout the past 35 <br />years. <br />((Ip,/ 5 G GG: b1,~5 a~dc~~f <br />__, .. <br />