Agenda - 04-16-2002 - 8e - Laserfiche WebLink

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FOR OFFICE USE ONLY A t+h mI V upree Sar �- VOLUNTEER APPLICATION ORANGE COUNTY ADVISORY BOARDS AND COMMISSI0 NOV - 5 _ If you are an Orange County resident, at least 18 years old, and willing to volunt expertise to your community,please complete this application and return to: � MAIL: TELEPHONE/COMPUT. I. Orange County Commissioners'Office (919)245-2125;245-2129;245-2130;732-8181 Post Office Box 8181 FAX: (919) 644-0246 Hillsborough,North Carolina 27278 EMAIL:npaciga(a,co.orange.nc.us NAME: ADDRESS: 570 /DA CITY,STATE,ZIP CODE: EMAIL.ADDRESS: C°• a 7 5.7 � TELMHO'13E#(WO TELEPHONE#0I0MED: 7,3j --1.(o9s 73a— 8699 PLACEnnOF--EMPLOYMENT: JOB TITLE: 1.W IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION;PLEASE INDICATE YOUR TOWNSHIP OF RESIDENCE: ❑ BINGHAM ❑CHEEKS ❑ HILLSBOROUGH ❑ ENO ❑ CHAPEL HILL ® LITTLE RIVER ❑CEDAR GROVE INADDITION,PLEASE INDICATE IF YOULIVE IN ONE OF THE FOLLO MNG AREA: ❑JOINT PLANNING AREA ❑ EXTRATERRITORIAL AREA ❑TRANSITION AREA IN OUR EFFORTS TO ASSURE DIVERSITY OF MEMBER BY AGE, GENDER, AND RACE, PLEA ANSWER THE FOLLOWING QUESTIONS: N FEMALE MALE ®AFRICAN AMERICAN ❑CAUCASIAN ❑ HISPANIC ❑ NATIVE AMERICAN ❑OTHER DATE OF BIRTH: PLE SE LIST(IN ORDER OF PREFERENCE) THE BO SACOMWSSIONS ON WHICH YOU WD LD BE WILLING TO SERVE Z. 3. 1)h WORK EXPERIENCE: a- f L aLk,,� Jp� -k� 4, �--t om-v� l96o- A601. jqef M 0L,1L �9- UX.UL 44h, IZ4d =s) 14 1,