Orange County NC Website
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l lv <br />FQR OFFICE USE.ONLY <br />Q±r ick , S Lt I i L) n <br />tt Z Page o Z <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 daA17 <br />P.O. Box 8181s?U ?'r9R, ADI <br />Hillsborough, NC 27278 <br />Phone (919) 732-8181; 688-7331; 9684501; ?0;N <br />Ext. 2125, 2129 or 2130 • Fax: (919) 6444 NAME: <br />9 <br />i - fill <br />HOME ADDRESS: <br />CITY: Zip Co e: ,? <br />TELEPHONE; (H) 0?a7 (W) 6?'^aSoo (Fax) <br />EMAIL: 4) 4 - SrLk (tjV- r'A-' laC? . lto? <br />PLACE OF EMPLOYMENT: XAC 64`4, JOB TITLE: ??? P soT <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR <br />TOWNSHIP OF RESIDENCE: Bingham Cheeks <br />Hillsborough Eno <br />Chapel Hill Little River <br />Cedar Grove <br />IN ADDITION, PLEASE INDATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />Joint Planning Area ?x Extraterritorial Area Transition Area <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP AGUE, 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: 62 r -7 <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE' BOARDS/COMMISSIONS ON WHICH <br />YOU WOULD BE WILLING TO SERVE. <br />2. <br />3 <br />(COTE' a63 L_4K:e Manor Loud i5 irl Carr {--?orp 0 ity/ Ll mits.