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FOR OFFICE USE ONLY t' <br />?I o F 'Z 1? 1??G 1 f'l i 0? l--r ?,?Vi ? <br />5 <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 to: <br />Orange County Commissioners' Office <br />P.O. Box 8181 <br />Hillsborough, NC 27278 <br />Phone (919) 245-2125; 245-2129; 245-2130; 732-8181 <br />Fax: (919) 644-0246 • Email: npaciga@co.orange.nc.us <br />NAME: V ,? '` R *I (? o l 'l <br />HOME ADDRESS: '",? LL U ?(, <br />CITY: H I is KJ6U ?.. Zip Code: <br />PHONE: (Day)`"/ l l - V_43 ` Evening/late LL/3-" ' 6 lax) 9t2-6 <br />EMAIL: <br />PLACE OF EMPLOYMENT: km 3S-JOB "j D_ <br />IN ORDER TO ASSURE COUNTYYVID EPRESENTATION PLEASE INDICATE YOUR TOWNSHIP <br />OF RESIDENCE: <br />O Bingham O Cheeks !4 Hillsborough O Eno O Chapel Hill O Little River O Cedar Grove <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />O Joint Planning Area O Extraterritorial Area O Transition Area <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING QUESTIONS: O Male 'R Female <br />ETHNIC BACKGROUND: O African Americans Caucasian O Hispanic Nati a American <br />O Other DATE OF BIRTH: 7 <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU <br />WOULD BE WILLING TO SERVE <br />,c <br />1. 2. 3. <br />WORK EXPERIE E: <br />K c