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<br />~~31 f 9~ ~• I of 2 /~nne}'t'e- J~ur~elsk~ <br />a,~j~ VOLUNTEER APPLICATION <br />,.~t <br />~h~~`~'~ORANGE COUNTY BOARDS AND COMMISSIONS <br />I f you are <br />volunteer <br />return to: <br />an Orange County resident, at Least 18 years old, and willing to <br />your time and expertise to your community, please complete and <br />County Commissioners' Office <br />P. 0. Box 8181 <br />Hillsborough, NC 27278 <br />NAME: <br />HOME ADDRESS: <br />~i~,s,p ~, ~ro~-~tc~n ~ ~~ _ Zip Code <br />TELEPHONE : ( W ) (~~9 ~ :lY~~ :~.~ 4 Q ( H ) q l i1 ~ - r YC~ ii <br />`` ~ec~,1~~ ~OI~C <br />PLACE OF EMPLOYMENT: Q,:~~e. ~lvi~Jk~ ~~~u "C~e~~`-er ~c~Y ~-~.~~cx=-` <br />i i 1 <br />JOB TITLE: ~ ~~ .a' ~;t.:~~u~~~t m~~~~~C~ <br />J ~Yill.~ <br />:~-~,~.4N REVERSE SIDE LIST JOB, VOLUNTEER, AND EDUCATIONAL EXPERIENCE AND/OR SKILLS <br />"''`''``~~'OU WOULD LIKE FOR US TO CONSIDER. <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP OF <br />RESIDENCE: <br />Bingham Cheeks <br />Hillsborough Eno <br />Chapel Hill Little River ~_ <br />Cedar Grove <br />WE ASK YOUR HELP IN ASSURING DIVERSITY~OF MEMBERSHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING QUESTIONS: <br />Male ETHNIC BACKGROUND: <br />Female ~, African American <br />' 'Caucasian <br />Native American <br />DATE O/F BIRTH <br />I; ,~~.,~/~ 3 n <br />Hispanic <br />,~_ Other <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS <br />WOULD BE WILLING TO SERVE. ~~P~o(. ~v/i~/y~ <br />,,`~ ~ mm~rTnnrna rw.. TFIR RLiVT4~1 <br />~~ <br />si . <br />`_; '3 . <br />4. <br />ON WHICH YOU <br />