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FOR OFFICE USE ONLY <br />P- 1 Z Mc,~+h4 <br />~~ k~ <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY BOARDS AND COMMISSIONS <br /> <br />If you are an Qrange County resident, at least 18 years old, and willing to volunteer your <br />time and expertise to your community, please complete this application and return to: <br />Orange County Commissioners' Office <br />P.O. Box 8181 <br />Hillsborough, NC Z7Z78 <br />Phone (919) 732-8181; 688-7331; 968-4501; 2Z7-2031 <br />Ext. 2125, 2129 or 2130 • Fax: (919) fi44-0246 <br />NAME: ~~~~~J~____~ R f4-k~~' . <br /> <br />CITY: ~ p Zip Code: <br />SuHMr~r~ <br />TELEPHONE: (H) ~`/q~Q~-,~(~ ~ !~ . 3`f7 `,lSr3a (Fax) ~ ~.-'' . <br />EMAIL: d <br />PLACE OF EMPLOYMENT: ~__._ <br />9' <br />dG <br />IN ORDER TO ASSURE COUNTYWIDE REPRE5ENTATION PLEASE INDICATE YOUR <br />TOWNSHIP OF RESIDENCE: Bingham Cheeks <br />Hillsborough Eno <br />Chapel Hiil ~ Little River <br />Cedar Grove <br />__.____~ <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />Joint Planning Area ~/ Extraterritorial Area Transition Area <br />WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER <br />AND RACE, BY ANSWERING THE FOLLOWING QUESTIONS: <br />Male ~ ETHNIC BACKGROUND:• <br />Female 1/ African American Hispanic <br />Caucasian ~ Other <br />Native American <br />DATE OF BIRTH: "~ ` <br />PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDSlCOMMISSIONS ON WHICH <br />YOU WOULD B WILLIN TO SERVE. ~iy.e~ ~ . ~ -¢ <br />1. <br />z. <br />3. <br />JOB TITLE: ^ <br />