Orange County NC Website
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FOR OFFICE USE ONLY <br /> l� <br /> jqj OU of <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 a <br /> expertise to your community, please complete this application and return <br /> Orange County Commissioners'Office <br /> P.O.Box 8181 DEC 9 <br /> Hillsborough, NC 27278 I i <br /> Phone(919)245-2125; 245.2129;245-2130; 732-8181 <br /> �n} qFax: (919) 644-0246 • Email: npaciga @co.orange.n . <br /> NAME: n���VE U• M <br /> HOME ADDRESS: -1100 Mr /49 M IE� 6d V Ka tf ROAD <br /> CITY: // �l. L 1, <br /> Zip Code: x79/4 <br /> PHONE: (Day) q J2-OW(Evening/late) (Fax) <br /> EMAIL: a- )221!� EP eq(''�rw/h k • ne�- <br /> PLACE OF EMPLOYMENT: No Mr JOB TITLE: I- I�I�II/IN'��� <br /> IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP <br /> OF RESIDENCE: <br /> O Bingham O Cheeks O Hillsborough O Eno XChapel Hill O Little River O Cedar Grove <br /> IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: ' <br /> O Joint Planning Area O 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: O Male XFemale <br /> ETHNIC BACKGROUND: O African American Xcaucasian CD Hispanic O Native American <br /> O Other DATE OF BIRTH: a A A-PR 1 I- dE6 <br /> PLEASE LIST(IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU <br /> WOULD BE WILLING TO SERVE. _ <br /> ADV cr'T C PM(r { OM E <br /> I. N41 ✓ ITI ADVISO Z\ 2. 3. <br /> �oMM►7TH. <br /> WORK EXPERIENCE: T/��-r niG�ycu��efi7-ia�1 .Tttz;7z�M�s 1, &Ur48&L /) <br /> ICJ IN e°i�-;tc�T #AAD CO Alm UN(2121 S'c-TVIVS-S - 5JQ52JL/sv c <br /> VOLUNTEER EXPERIENCE: ° n PAM 7a P -rij ;'_fi i?rV-nC, kto/ q QiFS I- <br /> 1111 - ?74 <br /> J , / <br />