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C harron AnAttWs <br /> JAN 2 6 1999 <br /> VOLUNTEER APPLICATION <br /> ORANGE COUNTY BOARDS AND COMMISSIONS If you are an Orange County resident, at least 18 years old, and willing to volunteer your time anc <br /> expertise to your community, please complete and return to: <br /> Orange County Commissioners'Office <br /> P. 0. Box 8181 <br /> Hillsborough, NC 27278 <br /> NAME: 'g,RON �1DR1NS <br /> HOME ADDRESS: 10 1 62tn Wong C <br /> LkrdQPj Zip Code <br /> TELEPHONE: (H) .X01 (W& 'afl5k;, (F) <br /> EMAIL tJ N6• l I'll <br /> PLACE OF EMPLOYMENT:-YY riAL f_ <br /> �p. <br /> JOB TITLE: h� <br /> ON REVERSE SIDE LIST JOB, VOLUNTEER, AND EDUCATIONAL EXPERIENCE AND/OR SKILLS YOL <br /> WOULD LIKE FOR US TO CONSIDER. <br /> N ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP OF <br /> RESIDENCE: <br /> Bingham Cheeks <br /> Hillsborough Eno <br /> Chapel Hill ✓ Little River <br /> Cedar Grove <br /> WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, B) <br /> ANSWERING THE FOLLOWING QUESTIONS: <br /> Male ETHNIC BACKGROUND: <br /> Female African American Hispanic <br /> Caucasian ✓ Other <br /> - <br /> DATE OF BIRTH: `- <br /> -7 3 <br /> PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU WOOL[ <br /> 6 BE WILLING TO SERVE. , <br /> 2. <br /> 3. <br />