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3/ <br />FOR OFFICE USE ONLY <br />Q. ~ ~ r 2 5aliy Gi bbs S h ooK _ <br />VOLUNTEER APPLICATION <br />ORANGE COUNTY ADVISORY 80ARD5 AND COMMISSIONS <br />if you are an Orenge 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; ~~ ~ ~ Q v <br />Orange County Commissioners' Office D V <br />P.O. Box 8481 <br />Hillsborough, NC 27278 ~~~ 5 ~~~ <br />Phone (919) 245-2125; 245-2129; 245-2130; 732-8181 <br />Fax: (919) 644-0246 • .Email: nmartin~co.orange.nc.u <br />~~ <br />~r..~ <br />HOME ADDRESS: ~ ~ ~, ~ ^L ~r e.T <br />CITY: ~ ~ ~~` Zip Code: 2 1 <br />PHONE: (Day) ~~ ~ (Eveningllate) ~ ~~. (Fax) S~~ti- <br />EMAIL: <br />PLACE ~I= EMPLOYMENT: x ~,~-c ~~ JO>3 TITLE: ~.~~ ~'~ ~ ~, ~~o`v <br />IN ORbER,TO ASSURE CO:UNTYVII1DE.l~EP-SLESENTA'i70N PLEASE INDICATEYOUR 1"OWNSHIP" " <br />OF RESIDEiv'l~E:..•"~ ~ ~ dK `7c-p <br />^ Bingham CI Cheeks ^ Hillsborough ^ Eno [~Chapei Hiil ^ Little River ^ Ceciar Grope <br />IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: <br />O Joint Planning Area D Extraterritorial Area O Transition Area <br />WE ASK YOUR.HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, <br />BY ANSWERING THE FOLLOWING 4UEST10NS: ^ Male ~emale <br />ETHNIC BACKGROUND: O African American Caucasian ^ Hispanic ^ Native American <br />^ Other ~ ATE OF BIRTH: ~ '~ 'Z`yi - ~ _ <br />PLEASE LIST (tN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU <br />WQULD BE WILLING TO SERVE. <br />d,b c G bks <br />Sc c c dpi ~5 Shook _ 5 g . 'P ol"~. <br />