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/D <br />FUR OFFICE USE ONLY <br />~• ~ a it ~ ~arr~i e <br />~fOL-I~NTEE#t AAAL- ICATaON- <br />ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS <br />„:241° <br /># 1resW are art~3range Oounty Tesldent, at least 18 j(ears old, arrdtrrilling tt3 voiunt~r Stour time aed <br />expertise to your community, please complete this appllcatbn and return ta: ,~ <br />w a1~ a~~_b. pd <br />ararrge County Board of Corrtmisslaners' O#flce <br />P.O. Box 8181 <br />HWabornugh,l~LC 272X& <br />Phone (919) 245-2125; 245.2129; 245-2130; 732-8181 <br />F''a-x:^^(919)644-0246 • Email: tacglaver(~ca.orange.nc.us <br />NAME: .~0~ r r j~ W 0..~, 0. C..~. u <br />f#3MB ADQRE'3S:L~0 l u5 ~~ i dra~ ~ C';~ys <br />CITY.- ~,~ `~ ~~ Id ~~ Zip Code: <br />PHONE: (Dayj ~ `t`f -a3 ~ 1 (t±vening/late) ~'f~~„3 $' 1 (Fax) <br />~. 7d.~ ~ <br />EMAIL; ~-L O ~ N T A ~ 5 ®C PR ~ l+ ~'~.NK_. NEY <br />-PLA~e~~-~ ~PtovM~: -Jo~ ~ a~ 4 ~~sE,~c .tOS T~Tt~:~,,,~~e~~` <br />JN DBEIER TD I~SLJRE CDtINTYYlfIDE l3EPRESENTA710NPZEASE 1AIUICATE YDLR TOWNSHIP <br />OF RESIDENCE: <br />^ Bln~ham O Cheeks ~ Hlligborouah O Eno O Chapel Hill O Little River O Cedar Grove <br />IN ADDRION, PLEA NDICATE IF YOU LIVE iN ONE THE FOLLOWING AREAS: <br />D Joint Planning ~ Extraterritorial Area O Tran tion Area _ <br />~F S L~~ <br />•YI~' A'.~ Y{}UR~i#EI:P'Ml'A - i-ilEM61°RSHIP BY AGE. GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING QUESTIONS: O Male ~l Female <br />ETHNIC BACKGROLND: O African American ~ Caucasian O Hispanic .O NaWe American <br />O Other DATE OF BIRTH: G' ~ 30~ G 1 <br />PLEASE I.iST (IN ORflER OF PREFERENCE) THE BOAROS/COMMISSiONS C31+1 WHICH YOU <br />WOULD BE WILLING TO SERVE. <br />1. <br />2. <br />3. <br />7fllDfiK ~xP~IC.>=: ~1 c;r c a.~e ~ ~ C.~D o1~ . Pt ~ rw ~ i s ~ ~.v~ ~S 5 ~. <br />~OL+~Nr~~R-fxPE~iI:NCE: <br />d b/ a~cn~ <br />~L cc : err <br />d,a~ / dtd ~~' <br />