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<br />FOR OFFICE USE ONLY <br />P• nv= 2 ?ak1y A bb5 S h ooK <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS <br />It you are an Orange County msldent, at least 18 years old, and willing to volunteer your time and <br />expertise to your community, please complete this application and return to: ,_ n <br />Orange County Commissioners' Office V <br />P.O. Box 8181 <br />Hillsborough, NC 27278 JUL 5 20M <br />Phone (919) 245-2125,,245-2129; 2454130; 732.8181 <br />Fax: (919) 644-0246 • .Small: nmartlnCeo.orange.ne. <br />HOME ADDRESS: <br />CITY: Dp Code: ? <br />PHONE: (Day)'k.-LA S (Eveningnate) _IR (Fax) S _ <br />EMAIL. <br />PLACE OF EMPLOYMENT: JOB TITLE: <br />IN ORbERTO ASSURE COUNTYWIDE.REPVMENTATION PLEASE INDIMXM-- (AUR TOWNSHIP" <br />OF RESIDE :.': t OK W-e r. r. ' <br />[3 Bingham ? Cheeks i3 H[llsborough O Eno XChapel Hill 0 Little River 0 Cedar Gro•?e <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE-FOLLOWING AREAS: <br />0 Joint Planning Area 0 .Extraterritorial Area 0 Transidon Area <br />WE ASK YOUR.HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING QUESTIONS: 0 Male emale <br />ETHNIC BACKGROUND: 0 African American Caucaslan 10 Hispanic 0 Native American <br />0 Other ATE OF BIRTH: % - <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU <br />WQULD BE WILLING TO SERVE. <br />ab G G Elks <br />so « dkCs Shook _sg .Yd?