Agenda - 12-02-2002-9g - Laserfiche WebLink

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~, o FOR OFFICE USE ONLY P. ~ o F .~ ~Q.,W r~ G' ~ P)Gke~t VOLUNTEER APPLICATION ORANGE COUNTY ADVISORY BOARDS AND COMMIS510NS If you are an Orange County resident, at least 18 years old, and willing to vo time.~ttd expertise to your community, please complete this application and return ton ~ ~ a M Orange County Commissioners' Office U P.O. Box 8181 'F~ ~ ~ l~~ Hillsborough, NC 27278 Phone (919) 245 2125; 245-2129; 245.2130; 732-8181 Fax: (919) 644.0246 Email: npaciga~co.orange.nc. NAME: !~~ ~ , ~,~ HOME ADDRESS: CITY: ~~~ ,rf~,(,L~ '~ , ~ _ Zip Cade: PHONE: (Day) x919,) 1 ~..9-P ~G S (Evening/late) 9~9 ~a9-~9G ~ (F~) EMAIL:. ~l.ci~~.tfi' otCZC~J n (~ ~tbfi-mat~Q. ~ ~m PLACE OF EMPLOYMENT: /,~y~ Q_„~,, /~,,,,,,~ JOB TITLE: -2°7~/ ~ IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION.PLEASE INDICATE YOUR TOWNSHIP OF RESIDENCE: - O Binghaer~ ~O Cheeks O Hillsborough O Eno Chapel Hill O Little River O~CedarGrove- 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 ~ Female ETHNIC BACKGROUND: O African American Q~ Caucasian O Hispanic O Native American O Other DATE OF BIRTH: /~_ ~-~i5' PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU WOULD BE WILLING TO SERVE. ~~~~ I:I r ` J 1. -fuf~i~'lG Nisrn~ C.C~ C 2.{t ~ C~1'C. C,f4G 3. l.~M rnA,.S~O-i rr- ~0-l C~n~O,~- WORK EXPERIENCE: IV(.L,r~: ~i I ~~.r-: ,.,) m c) l~ ~~~irr .4~nni~,t't . .>~ VOLUNTEER EXPERIENCE: