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<br />w <br />FOR OFFICE USE OgLY <br />~ ~~/o~. ~a e 1 of ~. ~c~7erf ~ ~q i 1 e <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS <br />If you are an Orange County resident, at least 1$ years old, and willing to volunteer your time and <br />expertise to your community, please complete this application and n: ~ 2 n ~ 2 <br />Orange County Commissioners' Office D L5 ll l.s <br />P.o. Box 8181 MAY i ~ 2002 <br />Hillsborough, NC 27278 <br />Phone (918) 245-2125; 245-2129; 245.2130; 732 <br />- Fax: (919) 644-0245 • Emall: nmartin~ca.oran <br />-NAME: ~=FT ~ .~1+ ~~,~~f <br />HOME ADDRESS: 6015 DEERWOOD LANE <br />CITY: - ~ ~( ORANGE COUNTY) <br />DuR~BH • N ~ ,~ _ _, _ Zip Code: 2 7 7 5 <br />PHONE: (Day) 919 383 (Evening/late) SArawF. (Fax) <br />EMAIL: ~ NONE <br />PLACE OF EMPLOYMENT: RETIRED ,,,,_JOB T17LE: <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP <br />OF RE5IDENCE: <br />D Bingham ^ Cheeks ^ Hillsborough ~ Ena ^ Chapel Hill ^ Little River ~ Cedar Grove <br />iN ADDITION, PLEASE INDICATE 1F YOU LNE IN_ ONE OF THE FOLLOWING AREAS: <br />~ Joint Planning Area ^ Extraterritorial Area ^ Transition Area <br />WE ASK YOUR HELP IN ASSURING DNERSf1Y OF MEMBER5HIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING QUESTIONS: X~Male ^ Female <br />ETHNIC BACKGROUND: ^ African American Caucasian ^ Hispanic ^ Native American <br />^ Other DATE OF BIRTH: 6/23/30 <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDSICOMMISSIONS ON WHICH YOU <br />WOULD BE WILLING TO SER1/E. <br />1. ABC CONTRn~,n, ~RAN(~R RP nF nn,TUg~~gN~. PF.RRAN7+".j.'[. ADVT~nRy BOA. <br />WORK EXPERIENCE: rFAmrFrFr, D':BLIC ACC4T~tuT,i~--~N~-~9~6~ <br />PARTNER AND~R N _TpAT~ jjq FTRMS GTNru ]"Q77 <br />ASSOCIATE NEAL ~BRADSH R .A.ND TAYr.oR S-rNrT.. ~ qo~ <br />VOLUNTEER EXPERIENCE' TREASURER ST PHILIPS EPISCOPAL CHURCH <br />