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V <br />FOR OFFICE USE ONLY <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 vo r time and <br />expertise to your community, please complete this application and return to D <br />Orange County Commissioners' Office <br />P.O. Box 8181 FEB 19 2002 <br />Hillsborough, NC 27278 <br />Phone (919) 245-2125; 245-2129; 245.2130; 732-8181 <br />?,(}} Fax: (919) 644-0246``• Email: npaciga@co.orange.nc. <br />NAME: I??tL,Al -j(, P, <br />HOME ADDRESS: 0 <br />CITY: ? A 0 Zip Code': -27.57 <br />PHONE: (Day) L-919) fj_1 P9GY (Evening/late) ?9?9?4d9-?q? S' (Fax) <br />EMAIL: Tp.c-grdoujn Phbt-mahbt-mak, corn <br />PLACE OF EMPLOYMENT: U4 LdI4 lo," JOB TITLE; <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION. PLEASE INDICATE YOUR TOWNSHIP <br />OF RESIDENCE: <br />O Bingham .O Cheeks O Hillsborough O Eno Chapel Hill O Little River O-Cedar Grcve <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 d Female <br />ETHNIC BACKGROUND: O African American 0 Caucasian O Hispanic O Native American <br />O Other DATE OF BIRTH: 11-1-*6- <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU <br />WOULD BE WILLING TO SERVE. <br />1. 1l IP)G ?, C, 2. Ai4aL%-qCA-fu CA& 3. to M r1M.•5,;j r nvir4n?' <br />WORK EXPERIENCE: - . C. e { <br />VOLUNTEER EXPERIENCE: <br />