Agenda - 12-01-2003-9f4 - Laserfiche WebLink

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1~ Richard W. Pratt p. i/2 7/18/97 a"% . , ,:- ~~ VOLI7N7'EER APPLICATION ORANGE COUNTY BOARDS AND COMMISSIONS If you are, an Orange County resident, at least 18 years old, and willing to volunteer your time and exl>ertise to your community, please complete and return to: County Clommissioners' Office P. 0. Bax 8181 Hillsboro1ugh~•NC 27278 a P TKf+7 ~ ~ NAME: . , ._ ____ rr~ ~ HOME ADDRESS: l~~~D _ .5g s}y~P~L. (r~Ll. k~Zip Code_ 27a~/ TELEPHONE: (W) 414-'i~g'.E?~y00 (H) 9l4`'~"OC/~ PLACE OF EMPLOYMENT: _ ~A')..~•1~- , JOB TITLE: _ Ni°Q- ~~~~r 1 .~ SE SIDE LIST JOB, VOLUNTEER, AND EDUCATIONAL EXPERIENCE AND/OR SKILLS U WOULD LIKE FOR US TO CODfSIDER. IN ORDER TO ASSURE COUNTYWIDI: REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP OF RESIDENCE: Bingham Cheeks Hillsborough - ~o - Chapel Hill /• Little River Cedar Grove .___ WE ASK YOUR HELP IN ASSURING DIVERSITYlOF MEHBERSHIP BY AGE, GENDER AND RACE, BY ANS':TERING THE FOLLOWING EtUESTICNS: Male Female DATE OF BIRTH: ___ // 46 _ ETFINIC BACKGROUND: African American Caucasian Native American Hispanic Other PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU ~OULD BE WILLING TO SERVE. ~~, )~St / ~_ fYfMTCRTnN FOI( TRV llluV'T4IS,d~ 3. ~_ 4.