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/4 g <br /> FOR OFFICE USE ONLY <br /> 4 <br /> 20L l of 3 d MmeeJr . <br /> VOLUNTEER APPLICATION <br /> ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS <br /> If you are an Orange County resident, at least 18 years old, and willing to volunteer your time and <br /> expertise to your community,please complete this application and return to: <br /> Orange County Commissioners'Office P f11 c� c ads P.O. Box 8181 Hillsborough, NC 27278 A 2 5 ac,Phone(919)245-2125;245-2129; 245-2130;732-8181 <br /> Fax: (919)644-0246 • Email: nmartin&o.orange.nc.us <br /> NAME: Do U G A- 0 <br /> HOME ADDRESS: ��✓r / f' <br /> CITY: , //•i-. zip Code:-2- <br /> 2r <br /> PHONE. (Day) (Eveningllate),.a,� (pax) <br /> EMAIL: PA6 MDN'/26F-j& AD1.,Com <br /> —o <br /> PLACE OF EMPLOYMENT: JOB TITLE: <br /> IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP <br /> OF RESIDENCE: oK <br /> ❑ Bingham 0 Cheeks Q Hillsborough ❑ Eno eChapel Hill ❑ Little River ❑Cedar Grove <br /> IN ADDITION,PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br /> ❑Joint Planning Area ❑ Extraterritorial Area O Transition Area <br /> WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE,GENDER AND RACE, <br /> BY ANSWERING THE FOLLOWING QUESTIONS: ISrMale .13 Female <br /> ETHNIC BACKGROUND: ❑African American ErCaucasian ❑ Hispanic 11 Native American <br /> 13 Other DATE OF BIRTH: 71.dv', 1q, <br /> PLEASE LIST(IN ORDER OF PREFERENCE)THE BOARDS/COMMISSIONS ON WHICH YOU <br /> WOULD BE WILLING TO SERVE. <br /> 1. 9444;-..l.9444;-�+`- , <br /> ' i�,,.,,N 2. 3. w�. Grw•� <br /> WORK EXPERIENCE: o Q �J 0141- r27�.�,,,r,� <br /> 199-G� <br /> VOLUNTEER EXPERIENCE: Wit-rcCso �e��L'.C� <br /> • , / <br /> r + <br /> / r <br /> dbV olddrs: rLP rr`,P��r", s c S <br /> s c ✓ cc b�.s ' <br />