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<br />FOR OFFICE USE ONLY <br />~I/~~ <br />-Io~q <br />~~r s I~est- <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS <br />If you are an Orange County resident, at least 18 years old, and wi <br />expertise to your community, please complete this application and <br />Orange County Commissioners' Office <br />P.O. Box 8181 <br />Hllisborough, NC 27278 <br />Phone (919) 245-2125; 24.9-2129; 245-2130; <br />Fax: (919) 6440246 • <br />NAMf;: ~ k <br />l,} I o 3 <br />DDRESS: r A na <br />t, <br />~ 1 200! <br />~~ ~;~ <br />., <br />J„+f~ <br />I+~'/ I t <br />s// <br />V <br />CITY: 5 b 0 r o u0,~ ~ C . ,., „ . _ Zip Code• ~'L't '7 <br />PHONE: (Day) 7 32 - t9~~Il x L ys'(Evening/late) q 19 • ~ 33 , ~ ~ ,(Fax) 91~. h3a , ~v,~~ <br />EMAIL: _ WQ5"i0/e~hL. 0~'dnLl~12•'NC• US <br />J <br />PLACE OF EMPLOYMENT: v n n JOB TITLE: t7 i rP~l~ a +~ I <br />+~~~ [4~p~r ~ P n1~r1 C(r4h`~ <br />!N ORDER TO ASSURE COUNTYWI~ RESENTATION PLEASE INDICCATE YOUR TOWNSHIP <br />OF RESIDENCE; <br />D Bingham O Cheeks C,~Hilts6orough D Eno D Chapel Hill D Little River ^ Cedar Gl~o~~e <br />IN ADDITION, PLEASE INDICATE IF YOU LNE IN ONE OF THE FOLLOWING AREAS: <br />® Joint Planning Area O Extraterritorial Area ^ Transition Area <br />WE ASK YOUR HELP IN ASSURING DNERSRY OF MEMBERSHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING QUESTIONS: 4 Male Female <br />ETHNIC BACKGROUND: ^ African American ~ Caucasian D Hispanic D Native American <br />^ Other DATE OF BIRTH: <br />PLEASE LIST (JN ORDER OF PREFERENCE) THF~OARgS/~C~MMISSIONS ON WHICH YOU <br />WOULD BE WILLING TO SERVE. ~~ a a coo d 1j <br />1. 2. 3. <br />WORK EXPERIENCE: _ ~ rs "y P ('0 4 ~~N ~i~ . ~ I s I c. ~. 1.. D r <br /> <br />VOLUNTEER EXPERIENCE: <br />sc db/ G,ppt <br />