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J <br />:FOR OFFICE USE ONLY <br />b?l9t PtgP_ I o J Frances L.1)oua las <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 />tur to: <br />time and expertise to your community, please complete this application,pri <br />NAME: <br />-- - -HOME ADDRESS: <br />R (9 L9 <br />Orange County Commissioners' Office 4F, U U <br />P.O. Box 8181 NOV 6 1999 <br />Hillsborough, NC 2727$ <br />Phone (919) 732-8181; 688-7331; 968-4501; 227-20 F <br />Ext 2125, 2129 or 2130 • Fax: (919) 644-0246 <br />al, \- ,N)MO \?kGs <br />a L. L. & .\z.-Q <br />CITY: IkT - Zip Code. <br /> <br />TELEPHONE: (H) '- (W) q,. ,a Z Z-- (Fax) 1 !O ISM <br />EMAIL: <br />PLACE OF EMPLOYMENT: &?B;SL? Stic ." JOB TITL ' ,Ur_ V_ f LR2A-11 <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR <br />TOWNSHIP OF RESIDENCE: Bingham Cheeks f [ <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: 9?'Z- <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH <br />YOU WOULD BE W, IL441NG O SERVE. <br />1. b `1BOJ ?5 'iA, <br />2. <br />3.