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

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/~ ~f \ FOR OFFICE USE ONtY ' ~. ~~~ ~ ~ ~~ 2 ~jl~ ~ ~ ~ ~'~. . VOLUNTEER APPLICATION ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS If you are an Orange County resident, at least 18 years old, and willing to x ~lunteer your time and expertise to your community, please complete this application and return to.. Orange County Commissioners' Office , P.O. Box 8181 ~, '~~ ~ ~ Hillsborough, NC 27278 Phone (919) 245-2125; 245-2129; 2~5-2130; 752-8481 ~ _ _ Fa~c: (91916440246 • Email: nmarttn~co.orange.nc.lrs - NAME: ~ ~ ~ . - -.- HOME ADDRI:.,S~ ' ~ Zlp Code: - CITY: . PHONE: {Day 7~~~ra~ (EveningAate~ q~~~~ ~ R~ y0 ~ .(Fax) EMAIL: ~;~ r 1 LACE OF EMPLOYMENT: ~ ~ B ~"E: ~i~' " " """ ~-~D 111~- P IN.QRDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE iNDiC~-TE YOUR TOIN.NS1~liP- . OF RESIDENCE: p Bingham ^ Cheeks D Hillsborough D Eno ~ Chapei Hill ^ Lrttle River ^ Cedar Gra~-e IN ADDITION, PLEASE INDICATE IF YOU LNE IN ONE OF THE FOLLOING AREAS: ~loint Planning Area .0 Extraterritorial Area D Transition Area WE ASK YOUR HELP IN ASSURWG DNERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, BY ANSVYERING THE FOLLOWING. QUESTIONS: ~Nale D Female . ETHNIC BACKGROUNO:~f African American D Caucasian D His~nic O Native American D Other DATE OF BIRTH: PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDSICOAAMISSIONS ON WHICH YOU WOULD BE WILLI TO SERVE 2. ~- 5: WORK EXPERIENCE: VOLUNTEER EXPERIENCE: