Orange County NC Website
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la <br />w <br />FOR OFFICE USE ONLY <br />~/~~/oy Pag e 1 of ~ ~c~erf ~ ~i~ey <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS <br />if you are an Orange County resident, at least 18 years old, and willing to volunteer your time and <br />experEise to your community, please complete this application and re ~ ~ ~ ~n <br />Orange County Commissioners' Office D f <br />P.o. Box 8181 MAY 142002 <br />Hillsborough, NC 27278 <br />Phone (919) 245-2125; 245-2129; 245-2130; 732 <br />Fax: (919) 644-024ta • Email: nmartin~co.oran <br />HOME ADDRESS: 6015 DEERWOOD LANE <br />t ~( ORANGE COUNTY) Zip Code: 27705 <br />CITY- ,,,_. DURHAM, ,1~,,, ,1' <br />PHONE: (Day) 919 383_ 669 (Evening/late) 2sAMwF (Fax) <br />EMAIL: <br />NONE <br />PLACE OF EMPLOYMF~1'C: RETIRED JOB TITLE: <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP <br />OF RESIDENCE: <br />D Bingham ^ Cheeks ^ Hillsborough ~ Eno ^ Chapel Hi11 ^ Little River ^ Cedar Grove <br />IN ADDITION, PLEASE INDICATE IF YOU LNE IN ONE OF THE FOLLOWING AREAS: <br />~ Joint Planning Area ^ Extraterritorial Area ^.Transition Area <br />WE ASK YOUR HELP IN ASSURING DNERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING QUt=STIONS: X2: Male ^ Female <br />ETHNIC BACKGROUND: ^ Afrkan American ~Caucasfan ^ Hispanic ©Native American <br />^ Other DATE OF BIRTH: 6/23(30 <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE ~OARDSICOMMISSIONS ON WHICH YOU <br />WOULD BE WILLING TO SERVE. <br />1. ABC CONTR[] ,$,D ~RaNr_F nn nF_AL2JLT$TMF*;'~• PF.R~AN'F7:TiL. ATIVTSRR_Y BOA <br />WORK EXPERIENCE: rFRTrrrTFT1 ~rrrstrr+ nr+rnrT~TA~I+ ~I~Inr ~c~ <br />r~ ~ ^~~ mss 4T ~ <br />PARTNER AND ~RINCIPAT,,,,,TK FTRMS STN(`F 1Q"» - <br />ASSOCIATE NEAL BRADSHER AND TA T.OR STNf!F. i oar <br />VOLUNTEER EXPERIENCE' TREASURER ST PHILIPS EPISCOPAL CHURCH <br />