Orange County NC Website
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,..; <br />~. <br />3S <br />FOR OFFICE USE ONLY <br />a ~s l R l a f 2 R+ ~. e' se <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 application and return to: <br />Orange County Commissioners' Office ~ ~ ~ ~ ~~~~j ~ <br />P.O. Box 8181 i ~ ~--.--•~ • ----`--~ - <br />Hillsborough, NC 27278 <br />Phone (919) 732-8181; 688-7331; 968.4501; 227-2031 ~ ~~~ ~ 3 ;~ <br />Ext. 2125, 2129 or 2130 • Fax: (919) 644-0246 <br />- - -~ -. HOME ADDRESS: ~~--~ °~ /YJ~l~D©~ ~ ~C. / yam' <br />. CITY• _ ~ ~G~ ~/~~ ~-,.~' ' Zip Code• `7 S/ <br />TELEPHONE: (H) ~p`~~'7 (W) ~^ (Faxy ~~' I'I _ <br />EMAIL: <br />~--r-~ <br />PLACE OF EMPLOYMENT: _ ~ ~~4~~(~-e„ 17 JOB TITLE: ,~6 <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 />!N ADDITION, PLEASE INptCATE IF YQU LIVE IN ONE OF THE FOLLOWING AREAS: <br />Joint Planning Area i/ 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 ~ African American Hispanic <br />Caucasian ~ Other <br />Native American <br />DATE OF BIRTH: 1 ~ r- 09 ' aZ~j ~ ' <br />PLEASE LIST (iN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH <br />YOU WOULD WILLING TO S,~RV ~'~ ts.~d dd <br />1. ~ ` T~~ <br />2. .. ~ , <br />