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- zs <br /> <br />FOR OFFICE USE ONLY <br />?/ I8 I of 2. T&nei- Cho dCL n <br />/99 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 applicati ? rn to: 2 <br />Orange County Commissioners' Office D L5 <br />P.O. Box 8181 <br />Hillsborough, NC 27278 AUG 1?' <br />Phone (919) 732-8181; 688-7331; 968-4501; 227- <br />-Ext. 2125, 2129 or 2130 9 Fax: (919) 644-0246 - <br />NAMEt ` ?? > m 14 h <br />HOME ?ADDRESS: w <br />CITY: 1 1, d - Zip Code 1 &2 <br />/,:)(Fax) <br />Ile TELEPHONE: (H f l9 -?"5- f(AI770 3& <br />EMAIL: <br />PLACE OF EMPLOYM <br />r <br />JOB <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE Cheeks INDICATE YOUR. <br />TOWNSHIP OF RESIDENCE: Bingham <br />Hillsborough Eno <br />Chapel Hill Little River <br />Cedar Grove <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />Joint Planning Area Extraterritorial Area Transition Area <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER <br />AND RACE, BY ANSWERING THE FOLLOWING QUESTIONS: <br />Male. ETHNIC BACKGROUND:- <br />Female? African American - Hispanic <br />Caucasian Other <br />Native American <br />DATE OF BIRTH: <br />PLEASE LIST (IN ORDER OF PREFER NCE) THE? gOARDS/COMMISSIONS ON WHICH <br />YOU W UL E ILLING S RVE. dab ? <br />1. Oran. e uNry PLanpvo ,Boa•d <br />(.? <br />2. <br />3.