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<br />FOR OFFICE USE ONLY <br />• o <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 volunteer your time and <br />expertise to your community, please complete this application and return:,'.: = _. <br />Orange County Commissioners, Office <br />P.O. Box 8181 yam, <br />Hillsborough, NO 27278 'uCtr . <br />Phone (919) 245-2125; 245-2129; 245-2130; 732-8181 <br />Fax: (919) 644.0246 • Email: nmartin&o.orange.na.us <br />NAME:t %7ast?rs -- - _ _? <br />HOME ADDRESS: lo5?.d &AI Z& A_ <br />CITY: 23p Code: a 7S'?b <br />PHONE: (Day) f9/917 /-3rrd,r(e,r(Eventngftb) 911--770e' (Fax) <br />EMAIL: . <br />PLACE OF EMPLOYMENT: .?.,? JOB TITLE: ,4.i ,F., •rt?a ?.-?? . <br />IN ORDER TO ASSURE-COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP <br />OF RESIDENCE: <br />0 Bingham O Cheeks 0 Hillsborough la Eno 10 Chapel Hill I] Little River 0 Cedar Grope <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />0 Joint Planning Area 0 Extraterritorial Area 0 Transition Area <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING QUESTIONS: EI Male la Female <br />ETHNIC BACKGROUND: 0 African American 0 Caucasian O Hispanic 13 Native American <br />_ 0 Other DATE OF BIRTH: <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU <br />WOULD BE WILLING TO SE VE. <br />1. C'6?..?rlt¦c ?kvlarc.ne w 2. 3. <br />WORK EXPERIENCE: l? ?/...4c ???f._. p-• .,a?I.:.. (a f'FiP.4Ca: f r <br />10- <br />VOLUNTEER EXPERIENCE:— Ci= <br />641= Rn' a ear/H ?i,?cTN a .G/?iCe+o elid? ILVu .J.