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0 1. 1 <br />COUNTY OF LEE <br />— - -- _ - -_ -- HPPLIC:FiI ION "10 "JtKVE VN BO/- CRDS % %I;OIVIIVIIJSIONS -- <br />If you are a Lee County citizen interested in serving as a member of one of the County's Advisory Boards, <br />please complete the form below and mail to Clerk to the Board, Lee County Government Center, PO Box 1968, <br />Sanford, NC, 27331 -1968 or fax to 718 -4631. YOU MUST BE A RESIDENT OF LEE COUNTY TO APPLY. <br />BOARDS AND COMMISSIONS <br />�i <br />Sanford -Lee County Airport Authority <br />Agriculture Advisory Board <br />Americans with Disabilities Act (ADA) <br />Board of Adjustments (Lee County) <br />Board of Adjustments (Sanford) <br />Board of Equalization & Review <br />Cemetery Board of Trustees <br />CCCC Board of Trustees <br />Economic Development Corp. <br />Fire Advisory Board <br />Environmental Affairs Board <br />Board of Health <br />Industrial Facilities & Pollution Control Financing <br />NAME: <br />_ Jury Commission <br />Library Board of Trustees <br />Mid- Carolina Workforce Development Board <br />_ Parks & Recreation Commission <br />_ Planning Board (Lee County) <br />Planning Board (Sanford) <br />_ Rest Home - Nursing Home Advisory Board <br />_ Senior Services Advisory Board <br />_ Social Services Board <br />_ Transportation Advisory Board <br />_ Juvenile Crime Prevention Council <br />_ Criminal Justice Partnership Advisory Board <br />th. <br />MAILING ADDRESS: <br />• HOME PHONE: WORK PHONE <br />YEARS LIVING IN <br />LEE COUNTY: 1 DISTRICT YOU LIVE IN <br />�`�_ \ } Q- Z ?33( <br />E -MAIL A^ S _vv - , , o <br />,2— <br />MALE: _ FEMALE: /\ WHITE: %" BLACK: _ HISPANIC: _ NATIVE AMERICAN _ OTHER _ <br />(Information for the purpose of assuring a cross section of the community) <br />EMPLOYER: �z� `- �Q <a . J ��\ S L , C� <br />OCCUPATION: <br />OTHER MUNICIPAL OR COUNTY BOARDS /COMMITTEES ON WHICH YOU ARE SERVING: <br />(Generally, the Board of Commissioners desires to broaden participation on Boards /Commissions for as much citizen involvement <br />as possible; therefore per Board policy, appointees can serve on no more the two (2) Boards /Commissions at a time. <br />PLEASE LIST THREE (3) LOCAL PERSONAL REFERENCES AND PHONE NUMBERS: <br />/ (o 7 <br />s (�z <br />• SIGNATURE: \ \- `� DATE: S Z ( 0 <br />11 iJ -� �2,- >.�.�C'�`1.�i�r�� ✓z:�L�C��t,ct<mo- r�ti�j� -� <br />MkY 2 5 <br />