Agenda - 06-17-2003-9d2 - Laserfiche WebLink

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FOR OFFICE USE ONLY Glenn Wil VOLUNTEER APPLICATION ORANGE COUNTY ADVISORY BOARDS AND t~R !f you are an Orange County resident, at least 18 years old, and willing to volunteer your time and expertise to your community, please complete this application and return to: NAME: ~: Orange County Board of Commissioners' Office P.O. Box 8181 Hillsborough, NC 27278 Phone (919) 245-2125; 245-2129; 245-2130; 732-$181 Fax: (919) 644ii-0246 Email: npacigat~co.orange.nc.us Lt~i 1S~c~ HOME ADDRESS: '/_ CITY: - - Zip Code: ~ J S~1 "~ .., . _-- PHONE: (Day) ~I V (Evening/late) ~~`~`3~{Fax) EMAIL: ~ v4 ' f ~, ` PLACE EMPLOYMENT: lJ / yG Gl~ JOB TITLE: iN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE I KATE YOUR TOWNSHIP OF RESIDENCE: O Bingham O.Cheeka C? H=1laborough O Eno- Chapel Hill .O' Lattle~Ziver- O Cedar Grove- ~ -- - IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: O Joint Planning Area O Extraterritorial Area O Transition Area WE ASK YOUR HELP IN ASSURING DIVERSITY OF_~IIEMBERSHIP BY AGE, GENDER AND RACE, BY ANSWERING THE FOLLOWING QUESTIONS: ~l Male O Female ETHNIC BACKGROUND: O African American l~aucasian O Hlspan c O Native American O Other ATE OF BIRTH: ~ ~ `~ PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU WOULD BE WILLING TO SERVE. /~ ~~~ Q .- _ _-.. _. _ __ - - .-~_ .---r~~ .- 1. ~l~oN -L~ ,cam ~'v"a`-®'-="-'~ J~ ~ 3. 7/- ~/~ D - WO K EXPERIENCE: G(%J~•Z- ~ J ~ ~ ~8~ VOLUNTEER EXPERIENCE: