Agenda - 12-10-2002-9g - Laserfiche WebLink

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,~6 FOR OFFItE 115E ONLY VOLUNTEER APPLICATION ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS If you are an Orange County resident, at least 18 years old, and willing;to, volunteer your time and expertise to your community, please complete this application and retur~tp:; -: = ~ _ ~:. Orange County Commissioners' Office P.O. Box 8181 Hillsborough, NC 27278 ~~~ ~ 1 . Phone (919) 245-2125; 245-2129; 245..2130; 732-8181 Fax: (919) 644-0246 • Email: nmartin@co.orange.nc.us _.~. NAME: --syc /%~zas - ._ ._., HOME ADDRESS: /OSi,d C~o~ o,.~ CITY• ~ rr ~ /t/ [.- Zip Code: a ~S"/6 PHONE: (DaY) 1,_9i9J 7~/-3rsa,rG~s'(Evening/late) 9/~-~70~' ,. tFax) EMAIL: PLACE OF EMPLOYMENT: .fin` ,JOB TITLE: ,Gli/ .Fm.~r,rie~t .S•.-~/ IN ORDER TO ASSURE-COUNTYWIDE REPRESENTATION PLEASE 1NDICATE YOUR TOWNSHIP OF RESIDENCE: ^ Bingham ^ Cheeks ^ Hillsborough ^ Eno Fd Chapel Hill ^ Little River d Cedar Gra~~e IN ADDITION, PLEASE INDICATE IF YOU LNE IN ONE OF THE FOLLOWING AREAS: ^ Joint Planning Area ^ Extraterritorial Aron ^ Transition Area • WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, BY ANSWERING THE FOLLOWING QUESTIONS: EJ Male D Female • ETHNIC BACKGROUND: O African American ®Caucasian D Hispanic ^ Native American . _ _. _ ^ Other DATE OF BIRTH: ~/~ to S' PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU WOULD BE WILLING TO SEJZVE, 1. _ ~~,Ys~ .~i~v~,a,e.~.~ .._._ 2. 3. WORK EXPERIENCE: rsf/~~4c ~ a~~ f~ ,~4 x~, T, ~f,, ~,,•~_ /; ~£~,q ~` f~„ 7 .~