Orange County NC Website
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<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 <br />time and expertise to your community, please complete and submit this form. <br />Name: <br />Name Called: <br />Home Address: <br />Phone: (Day) <br />Phone: (Evening) <br />Fax: <br />Email: <br />Place of Employment: <br />Job Title: <br />Township of Residence: <br />Zone of Residence: <br />Sex: <br />Ethnic Background: <br />Date of Birth: <br />Dr Matthew Vizithum <br />67 Dogwood Acres Drive <br />Chapel Hill, NC 27516 <br />968-1065 <br />968-1065 <br />929-6122 <br />mvizithum@yahoo.com <br />Chapel Hill <br />Male <br />Caucasian <br />6/2/1971 <br />Please list (in order of preference) the Boards/Commissions on which you would be willing to <br />serve. 1. Board of Health 2. 3. <br />WORK EXPERIENCE: Veterans Hospital Durham, NC Private practice optometry TLC-Staff <br />referral laservision surgical center <br />VOLUNTEER EXPERIENCE: Organized and participated in many vision/glaucoma screenings. <br />EDUCATIONAL EXPERIENCE: Doctor of Optometry 1998 BA Biology/Biochemistry 1993. <br />OTHER COMMENTS: Member American Public Health Association and State Public Health <br />Association . <br />How did you become aware of Orange County volunteer opportunities? If Other, how? <br />By submitting electronic application, applicant agrees to Ethics Guidelines and agrees to attend <br />three-hour orientation. This form was submitted online, on 2/28/2003 9:16:42 AM <br />