Orange County NC Website
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a~ <br />3/4/9 R p. ~ jz <br />~"ane 1. SlOarks <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 time and <br />expertise to your community, please complete and return to: /~ 22 ~/J <br />`_.. ~ `V' 15 ~ L/ <br />Orange County Commissioners' Office "~ ~ ~ . <br />P. O. Box 8181 ;; ~ ~ ! „ <br />Hillsborough, NC 27278 g ~ <br />....r / _ I li~ E ~ ~~ <br />NAME: <br />HOME ADDRESS: <br />Code a. 7~ 3 <br />TELEPHONE: (H) ,?,~~-SL_ 93 (W) ~3~r/./~f (F) <br />EMAIL -~a S;'a- /~ m~r~~_°~ - . _ .. / <br />PLACE OF EMPLOYMENT; ~ ~ " ~ u~ - S e ~~- a•~~d , <br />JOB~TITLE: <br />ON REVERSE SIDE LIST JOB, VOLUNTEER, AND EDUCATIONAL EXPERIENCE AND/OR SKILLS YOU <br />WOULD LIKE FOR S TO CONSIDER. <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE {NDICATE YOUR TOWNSHIP OF <br />RESIDENCE:. ~ ~- - <br />Bingham <br />Hillsborough <br />Chapel Hill <br />Cedar Grove <br />Cheeks <br />Eno <br />Little River <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, BY <br />ANSWERING THE FOLLOWING QUESTIONS: <br />Male ETHNIC BACKGROUND: <br />Female ~ African American Hispanic <br />. Caucasian _~ Other <br />Native American <br />DATE OF BIRTH: <br /> <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU WOULD <br />BE WILLING TO ERVE. ~~d •b. <br />1. ~ r~ - .ppw~plr~ 3//b~99 ~Zred Ter d//t~nafe~ <br />2. r ~rmwtintf'lee C e <br />3. <br />