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04i14.i03 15:07 1BM-65-LUCENT-90TION SYSTEMS ~+ 919 644 0246 y0' 4 <br />POR OFFICE U5a ONLY <br />P~ I ~~2 Fred~riclc ~t ivroct.~ <br />VOLUNTEER APPUGATION <br />ORANGE GOUNTY ,4DVISORY BOARD S ANO COMMISSIONS <br />It you are an orange County resident, at least 78 years old, and willing to volunteer your Uma and <br />expertise 10 your community, phase complete This application and return to; <br />Orange County Board of Commissioners• Office <br />P.O. Box 8187 <br />Hillsborough, NC 27278 <br />Phone (919)2452725; 245.2729;245-2130;732.8787 <br />Fax: (870) 6440246 • Email: ncglovcr(ojco.orange.ne.us <br />NAME: _F2~DERIGK. S, j~,~DWI~ <br />HOMEADDRESS:?2~~~ ~`l,FD(L~ST 17(Z~ V~ <br />Ctrr:_ ~ t ~-~ T3DR.d kG I~ rp coda: a 7,Z 78 <br />PHONE: (Day) g~6~Z19'4'~69 (Eveningilate) q(q'~`l5°lozg (Fax) 33~~~~9-7623 <br />EMAIL: -F ~i ro wn 16 ®n C , r r. co n^ <br />PLACE OF EMPLOYMENT:.. ~ ~M „~_ JOB TITLE: _~ 1"S~~ld~'sf ~ Ser%o~ <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP <br />OF RESIDENCE; <br />D Bingham O Cheeks Q Hllisbdrough ~ Eno O Chapel Hill O Lithe River O Cedar Grove <br />IN ADDRION, PLEASE INDICATE IF YOU UVE IN ONE OF THE FOLLOWING AREAS; <br />D Joint Planning Area D Extreterritdriai Area D Transition Area <br />WE ASK YOUR HELP I N AssuRING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING OUESTIONS: (S Mato ^ Female <br />E71iNIC BACKGROUND: 'African American D Caucasian D Hispanic O Nativo American <br />O Other DATE OF BIRTH: <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDSICOMMISSIONS ON WHICH YOU <br />WOULD BE WILLING TO SERVE. ~~ -t~ '~ J~ <br />7. C A I~L~7~~c~uisoxp 2. SnTo/n~/,+n 1e~~l~u] Ya. i~,'r'~s~ovaie~'`' <br />WORK EXPERIENCE: <br />EXPERIENC <br />~f <br />(~ <br />dcc'~.ech7+~.,~ <br />of i ~ u/'rr~a~i ~~ -¢eu <br />/iL' ~D [•.t1~ u(4. i do <br />C~,am ber-o(• lommerce, <br />U.+4X. <br />a'~ ~ <br />tD l <br />D01 <br />adc9~~ '~`^Pj. <br />