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__ <br />.. 1 <br />~5 <br />FOR~OFFICE USE ONLY <br />of 18f99 t of 2 ~ariet Chaomar~ <br /> <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 <br />time and expertise to your community, please complete this applicati turn to: <br />Orange County Commissioners' Office D ~ ~ ~ a v <br />P.O. Box 8181 <br />Hillsborough, NC 27278 '~ ~ ~ '~~; i <br />Phone (919) 732-8181; 688-7331; 968.4501; 227- " . <br />-Ext. 2125, 2129 or 2130 • Fax: (919) 644-0246 ~ --~-~ - <br />~_ ~ ~m ~4.h _._.... _.... - <br />_ , <br />HOME ADDRESS: Q{Co /~.. (_.U ~}- d -e ~.~~ "'7o C~ <br />CITY:.. t ~~ ~ - d ~ Zip Code 7 ~~ <br />TELEPHONE: (H f ~'~ ~73~-~SZC~~b/1-~5~.~770 3~ Fax) <br />EMAIL: <br />PLACE OF EM <br />r <br />JOB <br />IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR <br />TOWNSHIP OF RESIDENCE: Bingham Cheeks <br />Hillsborough --~ Eno <br />Chapel Hill Little River <br />Cedar Grove <br />1N 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 BACKGRQUND:• <br />Female African American ~/ Hispanic <br />Caucasian / Other <br />Native American <br />DATE OF BIRTH: ~L~`-~ <br />PLEASE LIST (IN ORDER OF PREFER NCE) THE OARDS/COMMISSIONS ON WHICH <br />YOU W UL E ILLIJ~G S RVE. ~ ~ ~ Boa.-d <br />1. ~ Drr~n e G~vaNry P~C.a~nirtg <br />2. <br />3. <br />