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

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•_ -^ :.rOR OFFICE USE ONLY ~l ~t l~/99 9 ~ ~ Frances ~., ~ VOLUNTEER APPLICATION ORANGE COUNTY 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 _ turn to: Orange County Commissioners' Office P.Q. Bax 8181 Hillsborough, NC 27278 Phone (919) 732-8181; 688-7331; 968-4501; 227 Ext. 2125, 2129 or 2130 . Fax: (919) 644-0246 r.~-~ NAME: _ ~R-~ ~~ ~.. ~ ~ ~ ~S D NOU 161999 . _ti-__ -..~-NOME ADDRESS: ~~'31D ~, ~, ~' , ~,p rr J _ . __ ....... _... _ - .- •.___ CITY: _ 'C~~~.-~1~~t ~~- ~ Zip Code. v~~"~ TELEPHONE: (H) ~ 'Z- (W) ~; Z.- Z~ {Fax) I b~"'- ~~~ ^+ EMAIL:' PLACE OF EMPLOYMENT: _~$~t~l~l,J ~~' JOB TITLQ~;Q. ~~ (~~~~ IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP OF RESIDENCE: Bingham Cheeks Hillsborough ~ Eno -`- Ghapel Hill Little River ~- CedarGrove ~_ IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: Joint Planning Area Extraterritorial Area Transition Area WE ASK YOUR HELP iN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, BY ANSWERING THE FOLLOWING QUESTIONS: Male -'-~~ ' ETHNIC BACKGROUND: Female ~-- African American His antc ~ Caucasian ~ Other Native American DATE OF BIRTH: 'Z.~ PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU WOULD BE WIL~ING TO SERVE. -- 2. 3.