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FOR OFFICE USE ONLY V-) <br />`Z ?g1f?1Q C?:??1?? <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS <br /> <br />If 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: <br />Orange County Commissioners' Office <br />P.O. Box 8181 <br />Hillsborough, NC 27278 <br />Phone (919) 245-2125; 245-2129; 245-2130; 732-8181 <br />Fax: (919) 644-0246^ Email: npaciga@co.orange.nc.us <br />NAME: f-L '1 o- ( o l <br />HOME ADDRESS: O y U ?__ ?= <br />CITY: I lS IDfV C Zip Code: G <br />PHONE: (Day)g1 [ -Vq3 ` Evening/late) ?,,Y -?- r 6lax) g (0 1/3.-X <br />6 <br />EMAIL: <br />PLACE OF EMPLOYMENT: JOTITLE: <br />IN ORDER TO ASSURE COUNTYWID EPRESENTATION PLEASE INDICATE YOUR TOWNSHIP <br />OF RESIDENCE: QV,? <br />O Bingham O Cheeks Hillsborough O Eno O Chapel Hill O Little River O Cedar Grove <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />O Joint Planning Area O Extraterritorial Area O Transition Area <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING QUESTIONS: O Male '1 Female <br />ETHNIC BACKGROUND: O African American © Caucasian O Hispanic Nati a American <br />O Other DATE OF BIRTH: 7 <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU <br />WOULD BE WILLING TO SERVE <br />1. I 2. _ 3. <br />WORK EXPERIE , E: <br /> <br />Wk\Sb,Tw1\V, c? Gl L <br />cc <br />\K 010-