Agenda - 12-02-2002-8b3 - Laserfiche WebLink

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6 FOR OFFICE USE ONLY 9-G~o2 I~a~o Ie~'2 ~r• Je55iGay. Lee VOLUNTEER APPLICATION ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS If you are an Orange County resident, at least 18 years old, and willing to vol expertise to your community, please complete this application and return to: Orange County Commissioners' Office -~ P.O. Box 8181 4 :: Hillsborough, NC 27278 ~~ i ~i. Phone (919) 245-2125; 245-2129; 245-2130; 732-8181 Fax: (919) 644-0246 Email: npaciga@co.orange.nc.uk-- -- NAME: _-~~. 5eS5 f c~ L- ~-~~ ~ ------------ - HOME ADDRESS: _ ~ ~ ~ G IIL'~_-YYI~_'L _ ~..G~ CITY: _L~~--1~-LJ.1-- - - - .Zip Code: ~ 5~~-- PHONE: (Day) _~~' -~ZS~- (Evening/late) CI J ~~3 S p~ (Fax) ~~ EMAIL: 1 S i ~_ Z ~e~ ~~2.,r1 d~- ~vt~t_, _C,l,!'1 c~ . e~C.~ _ PLACE OF EMPLOYMENT: C~1~11G_~~:~Ld~~~B TITLE: ~~C~(~~~I~~ Q rJ~v ssr~Y- IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP OF RESIDENCE: O Bingham O Cheeks O Hillsborough O Eno ~hapel Hill O Little River O Cedar Grove IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: O Joint Planning Area O Extraterritorial Area O Transition Area WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, BY ANSWERING THE FOLLOWING QUESTIONS: O Male ~emale ETHNIC BACKGROUND: O African American O Caucasian O Hispanic O Native American Other G~J ~ DATE OF BIRTH: -~~6 6~ PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU WOULD BE WIL,/L~ING TO SERVE. WORK EXPERIENCE: r~ ~~ ~l_ - laa ~_ iaaer Ylb c I~ I~t1~~,. , C1, h,,~ ~n ..,~/ .~ l1r~r 110,,,.,, ~i ~J ~~J rr~/ ,~ VOLUNTEER EXPERIENCE: