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<br />1 <br />FOR-OFFICE USE ONLY <br />g 9 1 of 2 Tanei- Chaon-)mn <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 applicatrAW o. <br />Ora <br />nga Coun? Commissioners' Office P.O. Box 8181 <br />Hillsborough, NC 27278 . ?`? <br />Phone (919) 732-8181; 688-7331; 968-4501; 227- <br />-Ext. 2125,2129 or 2130 9 Fax: (919) 644-0246 - <br />_ <br />NAME% fq1= -T C_,? a-l9 m A-j2 <br />HOME ??ADDRESS: ?)(CO /cd` (.(J ffi a t#L?rh?! ion ?l <br />CITY: .1?1, Zip Code -7&2 r <br />x3? <br />TELEPHONE: (He fi 41:u_ (Fax) <br />EMAIL: <br />PLACEI <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.INDICATE 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: <br />PLEASE LIST (IN ORDER OF PREFER NCE) THE OARDS/COMMISS <br />YOU W UL E LLING S RVE. Uk-*' <br />1. -- Dlztn a ?vcrNry <br />2. <br />3. <br />ONS ON WHICH <br />P,c.c?Boa.-d