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1~f <br />... <br />-'- Richard W. Pratt p. 1/2 7/18/97 <br />.;;• ,, <br />~ VOLtTN7'EER APPLICATION <br />ORANGE GOUNTY BOARDS AND COMMISSIONS <br />If you are: an Orange County resident, at least 18 pears old, and willing to <br />volunteer your time and expertise to pour community, please complete and <br />return to: <br />County Gommissianers' Office <br />P. 0. Bax 8181 <br />Hillsborough NC 27278 <br />~~. --~- <br />NAME: ^tD- <br />HOME ADDRESS: .~~ ~l~~~D ~ __ _ _ <br />- --._.~~L ~Z.l. ~!L- Zip Code 27~/'~-- <br />TELEPHONE : ( W ) ~IIR --dog.. F?zoo ( H ) 9!4 ~ ~" ~! ~ <br />PLACE OF EMPLOYMENT : ~~~ ~~- ~ - ~ -- <br />JOB TITLE: ~N~aQ CauSc~`1~Mtlr" <br />rREV~~SE SIDE LIST JOB, VOLUNTEER, AND EDUCATIONAL EXPERIENCE AND/OR SgILLS <br />U WOULD LIKE FOR US TO CODtSIDER. <br />IN ORDER TO ASSURE COUNTYWIDE: REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP 4F <br />RESIDENCE: <br />Bingham Cheeks <br />Hillsborough Eno <br />Chapel Hill ~ Little River <br />Cedar Grove <br />WE ASK YOUR HELP IN ASSURING DIVERSITY~OF MEHBERSHIP BY AGE, GENDER AND RACE, <br />BY ~ ANS ~'ERING THE FOLLOWIIr'G t~JESTIONS : - ~ -- ~ -- <br />Male / ETFfNIC BACKGROUND: - <br />Female Afz•ican American ~ Hispanic <br />' Catccasa.an Other <br />Native American <br />DATE OF BIRTH: <br />21, /tee <br />PLEASE LIST (IN ORDER OF PREFERENCE} THE BOARDS/COMMISSIONS ON WHICH YOU <br />~OULD BE WILLING TO SERVE. <br />ivt~ 1-st <br />2. <br />3. <br />4. <br />