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r/ <br />i (? <br />FOR OFFICE USE ONLY <br />p 1 Z Ma CL <br />?ruke- <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 <br />P.O. Box 8181 <br />Hillsborough, NC 27278 <br />Phone (919) 732-8181; 688-7331; 9684501; 227-2031 <br />Ext. 2125, 2129 or 2130 • Fax: (919) 644-0246 <br />NAME: <br />.,,_ ?. H.Q•NI?ADBR? ? ? r ? t.? ___._ ? RI??-??.-??r? ?_ ?y._.__? _ .__ _. - .____.. _? <br />n 1L d p ?- (?? Zip Code• <br />CITY: r n n - S V HM 15R . <br />TELEPHONE: (H) 6 (6 3`f 7 53a (F) A-M ?s <br />EMAIL: d <br />PLACE OF EMPLOYMENT: - JOB TITLE: <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE NDICATE YOUR <br />TOWNSHIP OF RESIDENCE: Bingham ECheeks <br />no <br />Hillsborough --- <br />Chapel Hill Little River <br />Cedar Grove <br />IN ADDITION, PLEASE pIDICATE 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: ,3 "S 'I <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDSICOMMISSIONS ON WHICH <br />YOU WOULD B WILLI TO SERVE. Orrdt? 44 • G -F <br />1. <br />2. <br />3.