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

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/~ FOR OFFICE USE ONLY 10-29-0~ - Q. t of ~- Eric B. Ti/Irv~a+1 VOLUNTEER APPLICA710N ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS If you are an Orange County resident, at least 18 years oid, and willing to volunteer your time and expertise to your community, please complete this application and return to: _ -., ~ --, Orange County Commissioners' Office J i ~~~ ~' E--•.`_ . '•=:.:. P.O. Box 8181 I/ -. W ~ ~ ~ ; ! i - Hillsborough, NC 27278 } ;~ ~ 9 ; Phone (919) 245-2125; 245-2129; 245.2130; 732-8181 - ~~ ~, . . . Fax: (919) 644-0246 'Email: npaciga@co,orange.nc.u ,~ ( ~ ` NAME: TLLMR~ ~i2.G 4. ~ _ _ --~_-- ----_.~ HOME ADDRESS: 325 NC. ~ No,~T~ cITY: /~iLLS Baeoc/~f/ . N. C. z;p code: Z 7278 PHONE: (Day) [9i9') sa 5/3-/~ ~3 (Evening/late) ~9~9~ GO - //`i~ . (Fax) (rJ/9) 6y3-- O~f7g EMAIL: . PLACE OF EMPLOYMENT: JOB T1TLE: IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP OF RESIDENCE: ~~ ~~ O Bingham O Cheeks (~}Iiilsborough O Eno ^ Chapel Hill O Little River O Cedar Grove IN ADDITIQN, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: O Joint Planning Area raten•itorial Area O Transition Area WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, BY ANSWERING THE FOLLO NG QUESTIONS: O Male O Female ETHNIC BACKGROUND: African American O Caucasian O Hispanic O' Native American O ether DATE OF BIRTH: PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU _ WOULD BE WILLING TO SERVE. ~ rlomrG L~~E CPryE~l7 2. WORK EXPERIENCE: Cho - laDcs Tax, ~ ~,~.I~l,$PD,~•T/I~~Oiv cS~i u'C~- ~,~~ ,~,~iLL~Bn.e~c~ 6N a ~ ~rs~~s ~ ,~o ~c~ns 1~u,¢_s~ a.~. ^/~-y~2r~-~S f~/1r~GE3SO/1 /,8~1 ' /~IS~T2.uc~a,~ ,t'A?s~ ~'C~~ICE I~ocKy ///oc~i,r-r-~Tsq/L,e4o/Lo, hl,C. ' . VOLUNTEER EXPERIENCE: +~L'cSou2~ /ANA-~~ ~t/~'T~s~I~l ~F~o~-`fr~° L~~uE fi~~L<.s.t3a,~~cl6f1 Sc c ~. d i rs t k a~~- o ~ r r-encu~ed-