Orange County NC Website
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~~~ ~ ~ S <br />` .~ FOR OFFICE USE ONLY , <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS <br />ff you are an Orange County resident, at least 18 years old, and wilting to volunteer your time and <br />expertise to your community, please complete this application and return to:r~ "~ . <br />NAME: , <br />H0~4iE ~- <br />CITY: <br />PHONE: <br /> <br />Zip Code: <br />(Evening/1ate~ q~~ ~(J • R~ YD (Fax) , <br />EMAIL: <br />PLACE OF EMPLOYMENT: ! ~ ~Q~~13 '~-E~ ,~i~t~f'Y~,7 ~D~l na <br />IN.ORDER TO RSSURE COUNTYVKIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP- <br />OF RESIDENCE: <br />D Bingham ^ Cheeks D Hillsborough ~ Eno ~ Chapel Hiil O Little River ^ Cedar G1'a~re <br />IN ADDITION, PLEASE INDICATE IF YOU LNE 1N ONE OF.THE FOLLOWING AREAS: <br />~,loint Planning Area .[7 Extraterritorial Area ^ Transition Area <br />WE ASK YOUR HELP IN ASSURWG DNERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING. QUESTIONS: ~.~Aale ^ Female . <br />ETHNIC BACKGROUND:,'l~African American O Caucasian D Wispanic ~ Native American <br />[] Other DATE OF BIRTH: <br />PLEASE LIST (W ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU <br />WOULD BE WILLI TO SERVE. <br />7. - - _ 2. ~ ... . _ ~.. <br />_ _ t <br />WORK EXPERIENCE: <br />Orange County Commissioners' Office <br />p,0. Box 8181 <br />Hillsborough, NC 27278 <br />Phone (919) 245-2125; 245-2129; ?45-2130; 732-8181 ~ ~ ~. <br />FaxJ;.~,919) 644-0246 Email: nmartin~co.orange.nc.us <br />VOLUNTEER EXPERIENCE: <br />