Agenda - 06-17-2003-9d3 - Laserfiche WebLink

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`~~3 ~ n~ :"• FOR OFFICE USE ONLY ' ~-- ~ 2 G t enn W ~ lson I~R ~2 6 ,~ f~ VOLUNTEER APPLICATION ~~- ORANGE COUNTY ADVISORY BOARDS AND COMMISSION - H 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: Orange County Board of Commissioners' Office P.O. Box 8181 Hillsborough, NC 27278 Phone (919) 245-2125; 245-2129; 245.2130; 732.8181 Fax: (/919) 644-0246 • Email: npaciga~co.orange.nc.us NAME: ~ ~e "h ~, ~ i ~ S~ y HOME ADDRESS: ~ `7 ~~~ ~ g(a-r7 ~ --Y'_ CITY: ~ Zip Code: °~ / Sr~ ~ .. _-- - PHONE: (DaY) ~'` ~/V (Evening/late) / ~53~ PLACE 19F EMPLOYMENT: [J /uG CST JOB TITLE: IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE I KATE YOUR TOWNSHIP OF RESIDENCE: O Bingham O. Cheeks O H8lsborough O Eno- Chapel Hill .O~ Ltttle~Ziver~ O Cedar Grove- ~ -- - ~ -- . IN ADDITION, PLEASE INDICATE IF YOU LIVE 1N ONE OF THE FOLLOWING AREAS: © Joint Planning Area O Extraterritorial Area O Transition Area WE ASK YOUR HELP IN ASSURING DIVERSITY OF~EMBERSHIP BY AGE, GENDER AND RACE, BY ANSWERING THE FOLLOWING QUESTIONS: Male O Female ETHNIC BACKGROUND: O African American ~aucasian O Hispan c O Native American O Other ATE OF BIRTH: ^ ~ y PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDSlCOMMISSIONS ON WHICH YOU WOULD 8E WILLING TO SERVE. _ _ N WO K EXPERIENCE: ~/l~c- ' ' VOLUNTEER EXPERIENCE: