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FOR OFFICE USE ONLY <br />~ ~ ~. Glenn u~~ls <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY ADVISORY BOARDS AND COM <br />1~ <br />i i .., . <br />c... <br />..~....r----- -'- <br />-+~R ~2 s ~:.: ~ ~. <br />if you are an Orange County resident, at least 18 years old, and willing to volunteer your time and <br />expertise to your community, please complete this application and return to: <br />NAME: U: <br />Orange County Board of Commissioners' Office <br />P.O. Box 8181 <br />Wilisborough, NC 27278 <br />Phone (919) 245.2125; 245-2129; 245-2130; 732-8181 <br />Fax: (1919) 644-0246 • Email: npaciga@co.orange.nc.us <br />vl ~ i ~ S~ v ~1 <br />HOME ADDRESS: ~ ~ ~ v ~a ~ `+~~ ~ ~- ._ .. _ -- ~7 / ..--~ - <br />CITY: ~ Zip Code: ~ / S~f ~ <br />// <br />PHONE: (Day) ~/ V (Evening/late) ~ `S`3t _(Fax) <br />EMAIL: e'~ <br />~, ` / <br />PLACE EMPLOYMENT: ~1 yG G~r JOB TITLE: <br />iN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE I KATE YOUR TOWNSHIP <br />OF RESIDENCE: <br />O Bingham O. Cheeks Q i-Bllsborough O Eno- Chapel Hill ~' L~ttle~Ziver ~ O Cedar Grove- ~ -- - ~ ~- <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />©Joint Planning Area O Extraterritorial Area O Transition Area <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF_411EMBERSHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING 4UESTIO.NS: (~ Male O Female <br />ETHNIC BACKGROUND: O African American ~aucasian O Hispan c O Native American <br />O Other ATE OP BIRTH: ~ ~ <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU <br />WOULD 8E WILLING TO SERVE. /~ ~,~ ~ ._ __..._. _,_. - ~ ~- --_-_- --/ ~~~ <br /> <br />VOLUNTEER EXPERIENCE: <br />