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<br />w -- <br />FpR OFFICE USE ONLY <br />~ /~/o Z ~a ~ ~ of ~, C1c~7Brf ~ f.~q i ~e <br />VOLUNTEER APPLICATION . <br />. ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS <br />If you are an Orange Gounty resid®nt, at least 1$ years old, and willing to volunteer your time and <br />expertise to your community, please complete this application and red--'-- - <br />Orange County Commissioners' Office D ~ ~ ~ u U ~ 1 <br />P.O. Box 8181 <br />Hillsborough, Nc x~z7s MAY 142002 <br />Phone (919) 245-2128; 245-2129; 245-2130; 732 <br />Fax: (819) 644-0246 • Email: nmartin~co_oran _ __ <br />•NAME: <br />HOME ADDRESS: 6015 DEERWOOD LANE <br />CITY: ~.. _... DLjRHAM . ~r J. ~ ORANGE COUNTY ) <br />_._,,, dip Code: 2 7 7 <br />PHONE: (Day) 919 ,3~3 7 6_ 6g (Evening/late) SA~~ (Fax) <br />EMAIL: NONE <br />PLACE OF EMPLOYMENT: JOB TITLE: <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP <br />OF RESIDENCE: <br />D Bingham D Cheeks D Hillsborough ~ Ena ^ Chapel Hill ^ Little River D Cedar Grove <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN_ ONE OF THE FOLLOWING AREAS: <br />~ Jolnt Planning Area D Extraterritorial Area ^ Transition Area <br />WE ASK YOUR HELP IN ASSURING DNERSI'IY OF MEMBERSHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING QUESTIONS: X~Male O Female <br />ETHNIC BACKGROUND: D African American Caucasian ^ Hispanic D Native American <br />~ Other DATE OF BIRTH: 6/23/30 <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU <br />WOULD BE WILLING TO SERVE. <br />1. ABC C`dNTRf1 Rfl ~BANf,F. R~~ nnT**~.*+~~ ~,~, pRR~ANx:T.T. An~rrennY gOA. <br />WORK EXPERIENCE: 1'F.RTT&'TFT1 DTTT2r Tn nn <br />~b~~~ ~~~ <br />PARTN R AND PRrNG1'PAr rA* FTRI-~R STNrr 1g7~ <br />ASSOCIATE NEAL ~BRADSHFR nu TAYTnR cry*n~ igg~ <br />VOLUNTEER EXPERIENCE: TREASURER ST PHILIPS EPISCOPAL CHURCH <br />