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V <br />FOR OFFICE USE ONLY <br />P. (o F 3 un C. ALke+f <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS <br />If you are an Orange County resident, at least 18 years old, and willing to vo <br />expertise to your community, please complete this application and return to D <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. <br />-F8 19 2002 <br /> <br />NAME: lqd. A M 6. r ? <br />HOME ADDRESS: <br />CITY: ? ,._. . <br />JJ _ - I/ II. C. - Zip Code: "275/ 1 10 <br />PHONE: (Day) L-91IJfi-9-PLG S' (Evening/late) (,74 ??ia9 9G S (Fax) <br />EMAIL: pi c,,k?,t7' aLw n lrrl bfi mat: , Garr <br />PLACE OF EMPLOYMENT: [ Ld24 ja4-4 JOB TITLE: <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION. PLEASE INDICATE YOUR TOWNSHIP <br />OF RESIDENCE: <br />O Bingham .O Cheeks O Hillsborough O Eno 06 Chapel Hill O Little River- 0-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 MEMBERSJHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING QUESTIONS: O Male LN Female <br />ETHNIC BACKGROUND: O African American T Caucasian O Hispanic O Native American <br />O Other DATE OF BIRTH: 11-2_-*6' <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU <br />WOULD BE WILLING TO SERVE. <br />1. Ju.rylnG 4vinne. Cj?t; 2. W tau jrt. CA& 3.'(20 m mXS4ri nuiran - <br />WORK EXPERIENCE: _ t <br />t <br />