Agenda - 01-21-2003-9e3 - Laserfiche WebLink

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FOR OFFICE USE ONLY P 'r) VOLUNTEER APPLICATION ORANGE COUNTY BOARDS AND COMMISSIONS If you are an Orange County resident, at least 18 years old, and willing to volunteer your time and expertise to your community, please complete this application and return to: Orange County Commissioners' Office P.O. Box 8181 Hillsborough, NC 27278 Phone (919) 732-8181; 688-7331; 968-4501; 227-2031 Ext. 2125, 2129 or 2130 • Fax: (919) 644-0246 NAME: MAMA 0 R 4fe r CITY: Zip Code: SuHM?? TELEPHONE: (H) ) !6 . -If 7 TSM (Fax) If EMAIL: / j DRAf< w f?01_ • O N1 PLACE OF EMPLOYMENT: JOB TITLE: IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP OF RESIDENCE: Bingham Cheeks Hillsborough Eno Chapel Hill 1/- Little River Cedar Grove IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: Joint Planning Area ? Extraterritorial Area Transition Area WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, BY ANSWERING THE FOLLOWING QUESTIONS: Male ETHNIC BACKGROUND:- Female 1/- African American Hispanic Caucasian ? Other Native American DATE OF BIRTH: "S PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDSICOMMISSIONS ON WHICH YOU WOULD B WILLI TO SERVE. -F DU M E ELI 1. 2. .5 3.