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/5 <br />FOR OFFICE USE ONLY <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS <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 <br />Orange County Board of Commissioners' Office <br />Hillllsborough1 NC 27278 7 2003 <br />Phone (919) 245.2125; 245.2129; 245.2130; 732 -818 <br />Fax: (919) 644 -0246 • Email: ncglover@co.orange. <br />NAME: MS. Sk J4 MyY4kIZI E <br />HOMEADDRESS:J�1 <br />CITY: Ohl vrcau�l�l' Zip Code: ZVI <br />PHONE: (Day) CAM)PM -211 (Evening /late) (11 �►ir�i�'J3's (Fax) <br />EMAIL: 54I1oe , Mf- k4nZiG <br />CPM <br />PLACE OF EMPLOYMENT -OW t4OS W- p WJkt U—"- OB TITLE: 4-6—\O-M! - HOWft -t- <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP <br />OF RESIDENCE: <br />O Bingham O Cheeks KHillsborough O Eno O Chapel Hill O Little River O Cedar Grove <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />O Joint Planning Area O Extraterritorial Area O Transition Area <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING QUESTIONS: O Male Wfemale <br />ETHNIC BACKGROUND: O African AmericanACaucasian O Hispanic O Native American <br />O Other DATE OF BIRTH: 11-11-14 14 <br />PLEASE UST (IN ORDER OF PREFERENCE) THE BOARDSICOMMISSIONS ON WHICH YOU <br />WOULD BE WILLING TO SERVE. <br />1. w1rJ I-��� umvg • 2. CvMM • Fob Wow�� 3. <br />�( M�1�rNq L00%DtN�' �V '�r(f` (�prtt�►f11 Iv�vintlNl. �pt•�. <br />VOLUNTEER EXPERIENCE: <br />6o4vc manwifien ! t t - crt> IG o>; cow •�tl l,caF veaN la# . <br />��w+nc6 T SoW� SWIMMINGI � Se+G6P1G.. <br />2�R - -DL F o MW11T4� . NOWUNM1190 f09 OG RAD6i 1, X1415 TSoMLn hg Vt2I;(ib1P-,f- <br />1N fi°(W - GMN wKit 'PK GatAt," w--r M0VAAV <br />