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<br />FOR OFFICE USE ONLY <br />P( n F 2 S41 Gi bbS G h ooK _ <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS <br />N you are an Orange County resident, at least 18 years old, and willing to volunteer your time and <br />expertise to your community, please complete this application and return to: a n <br />Orange County Commissioners' Office D U <br />P.O. Box 8181 <br />Hillsborough, NC 27278 JUL 5 ZQQ? <br />Phone (919) 245-2125; 245-2129; 245-2130; 7328181 <br />Fax: (919) 6440246 • Emall: nmartin@co.omnge.nc.u <br />HOME ADDRESS: \ ?„?T.^(,?r e-?" <br />CITY:- L\Ao!,kA4 ??? --- Z1p Code: 2 1 <br />PHONE: (Day) (Evening/late) "R iL -.. (Fax) S, e- <br />EMAIL: <br />PLACE OF EMPLOYMENT; f ? JOB TCTLE: ?.?•? ?'?,?,?o`v <br />IN ORIDER.TO ASSURE CQUNTYWIDE.REP AITATION PLEASE INDICA'TE7YOUR TOWNSHIP.- <br />OF RESIDE40E:..,'! OK <br />? BIngham O Cheeks O Hillsborough 13 Eno L Chapel Hill 0 Little River ? Cedar Gros <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THEFOLLOWING AREAS: <br />0 Joint Planning Area D Extraterritorial Area ? Transition Area <br />WE ASK YOUR.HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING QUESTIONS: ? Male Exemale <br />ETHNIC BACKGROUND: G African American Caucasian 10 Hispanic ? Native American <br />D Other ATE OF BIRTH: % - <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDSICOMMISSIONS ON WHICH YOU <br />W ULD BE WILLING TO SERVE. <br />1.3. <br />j\0 cC bks <br />Sc CC-., rs Shook _ s 9 . ?d?