Orange County NC Website
Browse       Search
/o <br />FpR OFFICE I1SE ONLY <br />s al~ol -- P~~,_.I ar- 2- ~L~,yini e. M. ~iirhmond <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 <br />_ _ __ _ expertise to your community, please complete this application and return t <br />Orange County Commissioners' Office <br />P.O. Box 8181 <br />Hillsborough, NC 27278 <br />Phone (919) 245.2125; 245-2129; 245-2130; 732-8181 <br />Fax: (919) 644-0246 •644.3004 Email: bblythe@co. <br />/~ ~.,.- <br />NAME: ~ .,. / V t, i ~ i ~/VVJ <br />aa'''')) TT o~-~i l <br />HOME ADDRESS: o4uc~ ~~r) 1/~f`alcl ~~ <br />CITY: <br />PHONE: (Day) ~c~'?'~:=~~T (Eveningllate) S/~/y`,e (Fax) <br />EMAIL: <br />PLACE OF EMPLOYMENT: <br />)B TITLE: ~~~. <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP <br />OF RESIDENCE: <br />^Bingham ^Cheeks Hillsborough ^ Eno ^ Chapel HIII ^Little River ^ Cedar Grove <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />t^~JOlnt Planning Area ^ Extraterritorial Area ^ Transition Area <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP' BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOL_LQWING QUESTIONS: ^ Male ~ Female <br />ETHNIC BACKGROUND: African American ^ Caucasian ^ Hispani ^ Native eri a <br />^ Other DATE OF BIRTH: (} <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU <br />WOULD BE WILLING TO SERVE. ~~ ~ 52rJ~, b~ ~ <br />~. <br />~YYdSC+~ <br />G~J/ 2.C'K.-1~~~ ~~e%~ 3.M~G7~1C,6~/Y ~ b <br />~X1Se ~1: <br />-~--° <br />EXPERIENCE:'/ 7i~s <b ~~ ~ /~ / l.1 {^( J <br />l,~Fj •~97 <br />-sc~ 'al ceo r aaiit., cx~t~" 7~uKE' ~ lR_~f - l`Pg~ <br />sE ~ e~ U>J• s ~ ~~C 1~~-(997 <br /> <br /> <br />BUG 2 1200) <br />Zip Code: p4 /~~g <br />VOLUNTEER EXPERIENCE: <br />