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3b- <br />FOR OFFICE USE ONLY <br />8123191 R I of 2 Ru+he Ntei s e I <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 />NAME: <br />Orange County Commissioners' Office , q 1U <br />P.O. Box 8181 D --- --- -_ w <br />Hillsborough, NC 27278 <br />Phone (919) 732-8181; 688-7331; 968-4501; 227-2031 AUb 2.3 <br />Ext. 2125, 2129 or 2130 • Fax: (919) 644-0246 <br />HOME ADDRESS: /0°Z <br />CITY://f7 Zip Code: <br />TELEPHONE: (H)F/9-4i'77 (W) (Fax) <br />EMAIL: <br />PLACE OF EMPLOYMENT: ?I_-rL-rZe? JOB TITLE: 6 r? <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 />IN ADDITION, PLEASE 7,Extraterritorial CATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />Joint Planning Area 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 i <br />LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH <br />YOU WOULD WILLING TO ERV Am etrfd 46 <br />1. <br />3. ?u r? d???cF?? <br />I?(a to t[ed IVA,?