Agenda - 09-02-2003-8b1 - Laserfiche WebLink

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~a FOR OFFICE USE pNLY 1 0~ 2 ~ .Busse I 1 ~e + k~er{- ~J VOLUNTEER APPL1CATiON ORANGE COUNTY BOARDS AND COMMISSIONS If you are an Orange County resident, at least 18 years old, and willing to volun#eer your time and ,expertise to your community, please complete this application and return to: Orange County Commissioners' Office D P.O. Box 8181. Hillsborough, NC 27278 Phone (919) 732-8181; 688-7331; 968-4501; 227.2031 ~ 2 g ~ Ext. 2125, 2129 or 2130 • Fax: (919) 644-0246 NAME: ussQ Il Se;,~~r-~. HOME ADDRESS: ~ 6~ q~ i ,~ y ~p /t~ c~ ciTY: ~ Il s ~ o~d ~ : ~ ~.. zip ccde:- ~~.~.> ~_.. TELEPHONE: (H) 'Y~-360 . (yy) a1.g _ f 39'7' (Fax) ~,~y,•.. 3 6 ~ •. EMAIL: ~~ S~, E,~ ~~~~ /~L oCD.o'J"~. J f~flrf nor PLACE OF EAAPLOYMENT:~ ;P(~ t~~~ Xro /~ JOB TITLE:,~r~iylp~s ~ ~ IN ORDER TO ASSURE COUNTYWIDE REPR S~ ENTATION PLEASE INDICATE YOUR TOWNSHIP OF RESIDENCE: Bingham ,,,,~`_ Cheeks _. Hillsborough ,Eno "` '~ Chapel Hill ~ ~ Little River ___.___~ Cedar Grove ~ ~ '^"`-` IN ADDITION, PLEASE INDICATE IF YOU LNE IN ONE OF THE FOLLOWING AREAS: Joint Planning Area Extraterritorial Area ~ Transition Area WE ASK YOUR HELP IN ASSURING DNERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE,. BY ANSWERING THE FOLLOWING QUESTIONS: Male . _ _ ~C ETHNIC BACKGROUND:• Female ~ African American Hispanic Caucasian ~ Other . Native American DATE OF BIRTH: g'~-i3-S~' PLEASE LIST (IN OftDER~~OF PREFERENCE) THE-B~~g / I~NS~N. WHIG. YOU WOULD BE WILD T SERVE. ~ Q~ 1. ~,~ L'0ntrn ~ S/ Oh. ~2. 3. .