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04i14i03 15:07 IBM-GS-LUCENT-90TIpN SYSTEMS ~ 919 644 0246 FOR OFFICE U51? ONLY ~ 2 F"redr/rck. ~ ~ Irv rain VOLUNTEER APPLJ CA710N ORANGl: COUNTY ADVISORY BOARD 5 ANO COMMISSIONS h you are an Orange County resident, a1 least 18 yeas old, and willing to volunteer your time and expertise t0 yow community, please complete this application aqd return tD: Orange County Board of Commissioners' O-NCe P.O. Bc~x 8181 Hillsbo~~ough, NC 27278 Phone 1;919) 24`x2125; ?A5.2129; Zds-2130; x32.8181 Cax: (9'119) 644-0246 Email; nrglever(~eo,orange.nc.us NAME: ~ RE.A ~ R I C k $~ ~ ,Q O W 1`1 HOMEApDRESS:?z~~~ ~~~~-~ F02~sT ~(z~ V~ CITr:_ ~- 11.15 73020 k<'~ I~ zipcDde: a ~a 78 PHONE. (Day) 3~6- 279- ~ ~~9 (Eveningltate) 9x4' ~`~S~~0Z5 (Fax) 33~ ~~ ~9- 76 Z 3 EMAIL: ~ ~ ra w r~ 16 ~~~ n c , r r, co r~ -_ M LPL ~ ~ r~~~ PIACE OF EMPLOYMENT: __, ~ ~ J08 TITLE: ~l ~ S ~~ :S .f/ Str- IN ORDER TO ASSURE COUN'1YVYIDE REPRESENTATIO N PLEASE INDICATE YOUR TQWNSHIP OF RESIDENCE: D Binsharn O Cheeks ~ HNlsborough ~ Eno O Chapel Hill O UtUe River O Cedar Grove IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: C] Joint Planning Area O trxtreterritarial Area O Transition Area WE A5K roUR HELP I N ASSURING DIVER5ITV of MEMBERSHIP er A6E, GENDER AND RACE, BYANSWERlNG THE FOLLOV~fING GUESTIDNS: ~ Male O Female ETHNIC BACKGROUND: ~A'liican American O Caucasian D Hispanic O Native American O Ol;he- DATE OF BIRTH: PLEASE LIST (IN ORDER OF i"REFERENCE) THE 80AR05/COMMISSIONS ON WHICH YOU WOULD BE WILLING TO SER1i'E. j~ 1. C A 3 L ~7/Ad ~iso,~y~ 2. SnTo~~r,~ ~ec.ht f a, ,~s. ~r'~/s a P~°L.u""'~d WORK EXPERIENCE: ~ der' Z~ ft/5 dT r'/1 vrMa~.wil ec~.~ ~ v~0 ~ e Ae-r~ ~.nce L+~~ ~~~- ~ or~kn c ~0 C.~~G~rti ; on VOL NTEERExPERIENCE: ~"'rePr~ ~r~ '~""'m 6e~_ "' ~Or-'~~ne~Cp ~~i-~~G( ~' S G/~~ ~r'r pr3 of Y/~ ~ A l~rba~r r~,„-s , d f _r - - a ~ !1 n/~_T81~1 inamm~n,'~ 11 ~; ~..,~ P.aoo.-~___. ~.~ db a~~ ~$ ac.~ °'a'~ ~t~ tv u~~ ~_,__. D01