Orange County NC Website
/3 <br />This space for ofHco use only ''.... <br />12/19/00 Page 1 of 2 Sam Lasris <br />VOLUNTEER APPLICATION <br />ORANGE COLiNTY BOARDS AND COM <br />If you are an Orange County resident, at least 18 yeazs old, and willing to vohmteer your time and <br />expertise to your community, please complete this application and return to: <br />Orange County Commissioners' Office <br />PA. Eox 8181 <br />Hillsborough, NC 27278 <br />Phone(919)732-8181;688-7331;968-4501;227-2031 <br />Ext, 2125, 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: (Home) ------- 732 7362 <br />TELEPHONE: (Work) ---------- 804 797 2357 <br />TELEPHONE: (FAX) ------- <br />EMAIL: -____-_-______-__~.. samlasris@hohnail.com <br />PLACE OF EMPI,OYMENI: ----- 395 S. Main St. Danville VA <br />JOB TTILE: ---------------Self-Employed General Dentist <br />TOWNSHIP OF RESIDENCE: --- Cedar Grove <br />ZONE OF RESIDENCE: -------- - <br />SEX: --------------_ _-_._--.._ _ Male <br />ETHNIC BACKGROUND: _---- Caucasian <br />DATE OF BBLTH: -------------- 121149 <br />LIST, IN PREFERENCE, THE BOARDS/COMMISSIONS ON WHICH YOU WOULD BE W1I,LING <br />TO SERVE; <br />1: ------------------- Orange County Planning Boazd <br />2. <br />3. <br />Please work, volunteer, and educational experience. <br />WORK EXPERIENCE: Self'Employed Dentist for 24 yrs <br />VOLUNTEER EXPERIENCE: I have served on vazious committees throughout the past 35 <br />yeazs. <br />(,~b/ 5C GG: b~5 addl~f <br />