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Application For Appointment To <br />Cabarrus County Advisory Boards and Commissions <br /> <br /> The Cabarrus County Board of Commissioners believes that all citizens should have the opportunity to participate in <br />governmental decisions. One way of participating is by serving as a citizen member of one of the County's advisory boards. <br />If you want to be considered for appointment to an advisory board, please complete thc form below and mail it to the Board <br />of County Commissioners, Post Office Box 707, Concord, North Carolina 28026-0'/07. You may detach this page and use <br />as a self-mailer. <br /> <br />Advisory Board / Commission Interested In: <br /> <br />Cabarrus Health Authority Board <br /> <br />Telephone: Home: <br /> <br /> Work: <br /> <br />N.C. Driver's License No.: <br />Occupation: '~ <br />Business Address: ~ff <br />Age (optional): ...... <br /> <br />Education~ Background: <br /> <br />Resident of Cabarrus County [] yes <br /> <br /> Circle your township <br /> <br />Central Cabarrus <br />Concord <br />Georgeville <br /> <br />Gold Hill <br /> <br />Number hours available per month [or this position: <br /> <br />[] no <br /> <br />Harrisburg New Gilead <br />Kannapolis Odell <br />Midland Poplar Tent <br />Mount Pleasant Rimertown <br /> <br />Other County Boards / Committees / Commissions presently serving on: <br /> Board, Committee, Commission: ,~d~c~2.~u~ <br /> Tc~ Expiratio~ Date' ~ ~-~ <br /> References <br />List throe ~rsons who am not related to you and who have definite ~owledge ofyour qualifications and fitness for the ~sition <br />for which you am applying. <br /> <br />Name i Business / Occupation Address Telephone <br /> <br />I understand that this application will be kept on the active file for two years only and I hereby authorize Cabarms County to <br />verify all information included in this application. <br /> <br /> Date ~ - l~'gnature orthe Applicant <br /> <br />,[--':. Cabarrus County Public Affairs Bulletin 'I'+ 7 <br /> <br /> <br />