Agenda - 06-17-2003-8b6 - Laserfiche WebLink

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'd•: FOR OFFICE USH ONLY G~~ J~ ~ ~ Pa g~e l o F 2 cSam ~}ab VOLUNTEER APPLICATION ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS if you are an Orange County resident, at least 18 years old, and wilting expertise to your community, please complete this application and returir~ // Orange County Cornmisslonecs' Office V P.O, Box 8181 :$~ w a 20~~ Hillsborough, NC Z7'27$ ~ ~~ Phone (919) X45-2125; 245-2129; ?.45 2130; y32.81 , , Fax: 919 644-0?.46 • .*~''...•:., • . I ) Email. nmartln~co.orange.,~ NAME: ~r~µ ~~bQ ~~. ... _.._.~.. ~__ _._ HOME ADDRESS: i~ ~!~ 7~ ;, J~ CITY: i ~. ~~~ n1 G ~ 0~'7 - Zlp Code: PHONI• ~ly~~- ~] ~{y `7 (Eveningllate) `'l 3. ~ - t~r/b~ (Fax) = /:~~- i O o~ `~{ EMAIL: ~.. Q C.4 t•JL PLACE OF EMPLOYMENT: ~~~. ar_~ JOB ~TtTLE: _ _ r~.~_~ IN ORDER TO ASSURE COUNTYWIDE REPRESEN'I'Ai~ON PLEASE INDICATE YOUR TOWNSHIP• OF RESIDENCE: O Bingham O Cheeks D Hillsborough D Eno D Chapel Hi11 d Little River~Cedar G1~a~re IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: D Joint Planning Area T~Extratenrltorlal Area t7 Tnnsitlon Area WE ASK YOUR HELP IN ASSURING DNERSITY QF ME1~gERSHIP BY AGE, GENDER AND RACE. BY ANSWERING THE FOLLOIMNG QUESTIONS;. R~Mala O Female ETHNIC BACKGROUND: D African American ~Caucasfan Q Hispanic D Native American •, D Other• ~ DATE Ol~ BIRTH: PLEASE LIST (IN ORDER OF PREFERENCE? THE BOARDS/COMMI3SION3 ON WHICH YOU WOULD BE WILLING TO SERVE 1. ~_~1r1~rC ~ ~, ~ ~ 3, - WORK EXPERIENCE: ~'~l't1KP-~.c. ~ M nn: ~~~•rrj 1. ~SC~ v:5~ ~ Q o F} ~. VOLUNTEER EXPERIENCE: + < ~ ~j ~. ~ " .~ Q~ . r~.. db/ cs G a ~~~ ~ ~ v ~ _~. ~~ ~ ~~