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<br />This space for office use only <br />Page 1 of 2 Sam Lasris <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY 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 to: <br />Orange County Commissioners' Office <br />P.O. Box 8181 <br />Hillsborough, NC 27278 <br />Phone (919) 732-8181; 688-7331; 968-4501; 227-2031 <br />Ext. 2125, 2129 or 2130 -Fax: (919644-0246) <br />NAME: --------____.-_~___ ___ Sam Lasris <br />HOME ADDRESS: --------- -- 7020 Caviness Jordan Rd. <br />CITY; __-__________-__-__________. Cedar Grove <br />STATE: --_____~._-------------_-- NC <br />ZIP CODE: ------------------ ----- 27231 <br />TELEPHONE: (Home) -------- ---- 732 7362 <br />TELEPHONE: (Work) --------- ---- 804 797 2357 <br />TELEPHONE: {FAX) ----________- <br />EMAIL: ----------._----- ~.... samlasris@hotmail.com <br />PLACE OF EMPLOYMENT: ---_- 395 S. Main St. Danville VA <br />JOB TITLE: ---------------._-__W Self-Employed General Dentist <br />TOWNSHIP OF RESIDENCE : --- Cedar Grove <br />ZONE OF RESIDENCE: --- ------ - <br />SEX; ----------------.~~____ Male <br />ETHI`iIC BACKGROUND: --- ---.-- Caucasian <br />DATE OF BIRTH: ------w_~_ _____ X21149 <br />LIST, IN PREFERENCE, THE BOARDS/COMMISSIONS ON WHICH YOU WOULD BE WILLING <br />TO SERVE: <br />1: --------------------- Orange County Planning Board <br />2. --------------------- <br />3. ------------------- <br />Please work, volunteer, and educational experience. <br />WORK EXPERIENCE: Self Employed Dentist for 24 yrs <br />VOLUNTEER EXPERIENCE: I have served on various committees throughout the past 35 <br />years. <br />db/ 5G GG:.1pI~S 0.ddl,~( <br />