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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: (919 644-0246) <br />NAME: ------------------------------- Sam Lasris <br />HOME ADDRESS: ----------------- 7020 Caviness Jordan Rd. <br />CTI'Y: ----------»--------------------- Cedar Grove <br />STATE: --_-_----------------------- NC <br />ZIP CODE: ----------------------- 27231 <br />TELEPHONE: (Home) ------------- 732 7362 <br />TELEPHONE: (Wozk) ------------ 804 797 2357 <br />TELEPHONE: (FAX) --------------- <br />EMAIL: ------------------------------ samlasris@hotmail.com <br />PLACE OF EMPLOYMENT: ------ 395 S. Main St. Danville VA <br />JOB TITLE: ----------_----------- Self-Employed General Dentist <br />TOWNSHIP OF RESIDENCE: --- Cedar Grove <br />ZONE OF RESIDENCE: ------------ - <br />SEX: ------..__---------------------- Male <br />ETHNIC BACKGROUND: --------- Caucasian <br />DATE OF B3RTH: ------------------ 121149 <br />LIST, IN PREFERENCE, THE BOARDS/COMMISSIONS ON WHICH YOU WOULD BE WILLING <br />TO SERVE: <br />1: ---------------------- Orangc County Planning Board <br />2. ---------------------- <br />3. ------------------- <br />Please work, volunteer, and educational experience. <br />WORK EXPERIENCE: Self Employed Dentist for 24 yrs <br />,~ <br />;, <br />VOLUN'T'EER EXPERIENCE: I have served on various conunittees throughout the past 35 <br />years. <br />db/ 5c GG= bks adA~( <br />,. <br />