Orange County NC Website
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<br />:7OR OFFICE USE ONLY !7 1 <br />?l I(o 1 a of G ?R71?GQ5 h you ?A5 <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 ?tuurrnto:non <br />Orange County Commissioners' Office D V L5 L1 y <br />P.O. Box 8181 NOV 16 1999 <br />Hillsborough, NC 27278 <br />Phone (919) 732-8181; 688-7331; 968-4501; 227-203 L - <br />Ext. 2125, 2129 or 2130 a Fax: (919) 644-0246 <br />NAME: 6 <br />_. -14nNF ADDRESS: <br /> <br /> <br />CITY: ?? Zip Code: <br />TELEPHONE: (H) (W) 't'Z Z 2- - (Fax) I p <br />EMAIL: <br />PLACE OF EMPLOYMENT: ' rite JOB TITLE 4L'7t ?Q- OF r C f 00s <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR <br />TOWNSHIP OF RESIDENCE: Bingham- Cheeks IL <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 <br />Caucasian <br />Native American <br />DATE OF BIRTH: Z-- <br />Hispanic <br />Other <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH <br />YOU WOULD BE WILWNG TO SERVE. <br />2. <br />3.