Agenda - 06-26-2003-9E1 - Laserfiche WebLink

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E- ~ .. ~ D ~ -_ _ . ~r.~ . ~ • FOR OFFICE USE ONLY ~~, y~~i ~- oz ~ p. t o ~ 2 Cha v-l~`~~~~k~-- -_..--- • VOLUNTEER APPLICATION ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS !f you are an Orange County resident, at least 78 years olds and wilpng to volunteer your time and expertise to your communlty~ please complete this application and return to: Orange County Commissioners' Office P.O. Box 8184 Hillsbarough~ NC 27278 • Phone (919) 245-2125; 245-2129; 245-2130; 732.8181 . - Fax: (949) 6440246 • Emafl: nmartin~co.orange.nc.us t4AR4E: C ~1 q h ~ tPi.S L~'~, . HOME ADDRESS: ~ ~ ,. a . F+n ~e~ FO -~5-~- ~r CITY: _ ~ C ~,a ~e I ~ N i ~ I,~ ~~ Zip Cede: o~ ~5~ PHONE: (Day) 6 ~ a " a So21 (IEveningllate) ~ 6 ~ ` ~ X36 (Fax) EMAIL: _ GM ~ Q nc.rr.cOlh ~ ~ . PLACE OF EMPLOYMENT: Se o rf5 Er-t{,PAVO rs ~,c, JOB TRLE: C KS~lo~ei` Sci vice ~2i~f- !N ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP OF RESIDENCE: D Bingham D Cheeks D H[Itsborough D Eno [Chapel Hil! D Little River ^ Ceaar Grope IN ADDITION,•PLEASE INDICATE IF YOU LNE IN ONE OF THE FOLLOWING AREAS: D Joint Planning Area ^ Extraterritorial Area ^ Transition Area - WE ASK YOUR HELP IN ASSURING DNERSlTY OF MEMBERSHIP BY AGE. GENDER AND RACE, BY ANSWERING THE FOLLOWING QUESTIONS: 63!'Male D Female - • ~ .. • • ETHNIC BACKGROLND:~ D African American C~Caucasian- ~D Hispanic a ' American- ~ •~ . O Other ~ DATE OF BIRTH: CI~ 0?9 '7,3 PLEASE LIST (W ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU WOULD BE WILLING TO SERVE. 1. ABC $Oane~ 2. P°urSofi-~.~ ~4dyiSory Boar~3, Agr~'cKl~trg~ Pi~ser•~tf~o~ Boy WORK EXPERIENCE: ~sPcrts ~-deavors .~`r~~. /H~lls~oroti~i~NC~CMs~o~-,serv,'ceA~ent • S('. . o20Q~' ~hi(;~h/ /4~1' li~ $ Mo/rilY~`~f ~(!C /~es~rva/t0Y1 sales A end Mq ~~ aool-s ~ fir. Po ~ Lee l~ov/klnal NG Roce ~NoniSf 0{fi~ce M~hq er TNxe aA~O--'=eb,aa~l ~` Iali a, J q~ ~nirersi Ga n~ u5 po5-F P~ Ce r~'-n~ q ~G worf~ S•lud /~ H • / yqs-Hq 1997 VOLUNTEER EXPERIENCE:~I`R4iSB-f!e Rvv-~ Pro,1~f'~Rowlg4~N~ -TII,~I~°-.1i aAd) ~- N Eck Re ryas S~ ~Sehq-I~ Cary a. Nor ! J"u 1 -- Nal , J ~9' ~ ~obeSan CvNhfy IN~IiC 08fuiders o,F~;'ce [`l.~w,be~~ti N ~ Vane- ~y9, /99~