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~o~i~ so~ APPOI~,,~ TO THE ~ITnE X× A~ P~I~ ~VISO~V <br /> <br /> 2. Mailing Address: <br /> Zip Code <br /> <br /> 3. Telephone: Bome Business <br /> 4. Ethnic Background: Black Indian White Other <br /> <br /> 5. Se~: Male Female <br /> <br />6. Age: <br />7. Education: <br />8. Occupation: <br /> <br />9. Community Interests and Activities: <br /> <br />10. Nominated to Represent (County): <br /> <br /> Personal contact was made and the individual agrees to serve on APAC. <br /> <br /> Date: Submitted by: <br /> Chairman, County Board of Comr. issioners <br /> <br /> <br />