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

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zy FOR OFFSGE USE ONLY Q- ~ ~ ~ 2 Scilly Gi bbs ~ h ooK VOLUNTEER APPLICATION ORANGE COUNTY ADVISORY BOARDS AND COMMlSSiONS !f you are an Orange County resident, at least 18 years old, and waling to valantesr your time~an~Id expertise to your community, please complete this application and return to: ~ ~~~ Orange County Commissioners' Office D l5 v P.O: Box 8181 Hillsborough, Nc 2727$ ~ JUL 52001 Phone (919) 248-2125; 245 2129; 245.2130; 732.8181 Fax: (919) 644.0246 • .Email: nmartin@co.orange.nc.u HOME ADDRESS: ~ [1~_~6_-~(`ti. C_~- cITY: ~~~~~~~~~ ~ zip code: ~ PHONE: (Day) ~1A - '~ Z3 ~ (Eveningllate) ,~ ~~. ~ (Fax) S G. `~'h~ EMAIL: _ ~~ PLACE OP EMPLOYMENT: ~ fi~-f 4 ~ JOB TITLE: ~~ti ~ ~ ~ ~~ -\ ~ ~~p`~ IN ORbER.TO ASSURE CQUNTYaAIIDEREPNTA'~'ION PLEASE INDICA'i'E~(.OUR TOWNSHtP•~ ~" OF RESIDEi:...'s dK ~x-P .. •: '= .. ^ Bingham ^ Cheeks ^ Higsborough ^ Ena .Chapel Hill d Little River ^ Cedar Gro•~e IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THEF04LOWING AREAS: D Joint Planning Arsa D ~Eutraterritorial Arsa ^ Transition Area WE ASK YOUR.HELP IN ASSURING DNERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, BY ANSWERING THE FOLLOWING 4UESTIONS: ^ Male ~emals ETHNIC BACKGROUND: G African American ~Caucaeian ^ Hispanic ^ Native American ^ Othsr DATE OF BIRTH: ~ ~- Z`"'(~ -~,~, PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU WQULD BE W1LLlNa TO SERVE deb ~G bks ~ cc d~rs - Shook_sg .'Pd-~