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Rx Date/Time FE6-17-2009(TUE) 1009 91977d3S1d P 001 <br />Feb-17-2009 11:18 AM Sanford Specialty Clinic 9197743514 1/1 <br />• <br />COUNTY OF LEE <br />BOARDSICOMMISSION APPLICATION <br />The Lee County Board of Commissioners believes that all citizens should have the opportunity to participate <br />In governmental decisions. One way of participating is by serving as a citizen member of one of the county's <br />advisory boards, listed below. If you have an Interest In being considered for appointment to one of the <br />boards, indicate by placing a check mark by your Interest(s), complete the form below, and mail to the <br />address listed at the bottom of the application. For additional information about our committees or to complete <br />an on-line application, please visit our web site at www.leecountvnc.oov. <br />BOARDS AND COMMISSIONS <br />Sanford-Lee County Airport Authority _ <br />Jury Commission <br />Agricultural Advisory Board _ <br />Library Board of Trustees <br />-Americans with Disabilities Act (ADA) _ <br />Mld•Carolina Workforce Development Board <br />_ Board of Adjustments (Lee County) _ <br />Parks & Recreation Commission <br />_ Board of Adjustments (Sanford) _ <br />Planning Board (Lee County) <br />Board of Equalization & Review _ <br />Planning Board (Sanford) <br />Cemetery Board of Trustees <br />Rest Home-Nursing Home Advisory Board <br />_ CCCC Board of Trustees - <br />Senior Senior Services Advisory Board <br />Lee County Economic Development Corporation - <br />Social Services Board <br />Lee County Fire Advisory Board _ <br />Transponatlon Advisory Board <br />Lee County Environmental Affairs Board _ <br />g Lee County Board of Health ( me,, 7L4 <br />Juvenile Crime Prevention Council <br />Criminal Justice Partnershi <br />Ad <br />i <br />B <br />d <br />p <br />v <br />oar <br />sory <br />• _ Industrial Facilities & Pollution Control Financing Auth. <br />NAME: <br />ADDRE; <br />Ci 2 <br />733 0 <br />HOME PHONE: -7 7 y- 3 7 7 9f WORK PHONE: 7 A l- U <br />PLACE OF EMPLOYMENT: _ /-4 N G SC1 it 7 D a( Sip r. / Ct l ~c/ Gtr A / <br />OCCUPATION: R 3 S N ~ li ] ~u S / U r/ `/1I Lt Y $ G ) <br />EMAIL: 7' r'0rr10ier CF u" Gh• u4A6C0'rc 775- 7915- <br />List any experience/quallllcatlons you have relevant to the above board/commission you are Interested in. <br />0'? CO/o4 S 1 G U~ 0 B/ G yN D~tf~C, tvi <br />._-S its a ,C a / P me c o. , Con Div <br />I CERTIFY THAT ALL OF THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE TO THE <br />BEST OF MY KNOWLEDGE. <br />DATE: a - / - I 2) <br />gnature of Applicant/ <br />NOTE: MUST BE A RESIDENT OF LEE COUNTY, AND CAN ONLY SERVE ON TWO (2) BOARDS AT A TIME. <br />Return completed application to: Ms. Gaynell Lee, Clerk to the Board of Commissionare, PO Box 1968, 106 <br />• Ilcrest Drive, Sanford, North Carolina, 27331-1968, or fax to 774-8407 or a-mall to aleelA ecountvnc oov. <br />Pu/r o/) 0/0ej'y YO1P fr c/o/o9,, e. c(®c✓,na/a9 y. <br />FEB 17 2N <br />