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<br /> <br />FQR OFFICE USE.ONLY <br />rtl?3/ 9 Page I o? Z +r ick NlS u (li Owl <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY BOARDS AND COMMISSIONS <br />If you are an Orange County resident, at least 18 years old, and willing to volunteer your <br />time and expertise to your community, please complete this application and return to- <br />Orange County Commissioners' Office 4 D,&, V, xo <br />P.O. Box 81811??flU / AR /9D1 <br />Hillsborough, NC 27278 <br />Phone (919) 732-8181; 688-7331; 968-4601; J ?? N <br />r-, Ext. 2125, 2129 or 2130 a Fax: (919) 644-02W'@ <br />Lo;?2 -4- /0 OL <br />NAME: / ,? <br />V4 2 P - <br />HOME ADDRESS: <br />CITY: Zip CO TO. <br />TELEPHONE: (H) a L 0? a 7 (W) (Fax) ?v S Y ^ 6 5 <br />EMAIL: <br />C4- ai x-41^ - (P- d"er , e ? <br />r <br />PLACE OF EMPLOYMENT: OKAt 64U?Jt JOB TITLE: SS's f Poser` <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR <br />TOWNSHIP OF RESIDENCE: Bingham Cheeks <br />Hillsborough Eno <br />Chapel Hill Little River <br />Cedar Grove <br />Female African American Hispanic <br />Caucasian Other <br />Native American <br />DATE OF BIRTH: 9 _ <br />IN ADDITION, PLEASE INDCATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: 7 <br />Joint Planning Area -?Extraterritorial Area Transition Area <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP AGE, GENDER <br />AND RACE, BY ANSWERING THE FOLLOWING QUESTIONS: C4u <br />Male ETHNIC BACKGROUND: <br />YOU WOULD BE WILLING TO SERVE. <br />1. Ca . S'?rcrr S?s..• f'?•sLcc? <br />2. <br />3 <br />PLEASE LIST (1N ORDER OF PREFERENCE) THE-BOARDS/COMMISSIONS ON WHICH <br />N OTC' 20_3 avv, MCir"or RU(I-d 15 fV} CO-'-" I, c' L: 011 Li r