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PUBLIC NOTICE TO RESIDENTS OF
PLANNING DISTRICT NINE Culpeper County—Fauquier County—Madison County—Orange County
Rappahannock County—Town of Warrenton Are you interested in quality health care for your .locality? Would you be interested in serving on an advisory council that will be working toward health care improvement in this area? If so, complete the following and return it to: NORTHWESTERN VIRGINIA HEALTH SYSTEMS AGENCY, INC. c/o John B. Capelle Executive Director Rappahannock-Rapidan Planning District Commission 702 S. Main Street Culpeper, Virginia 22701 NAME:-—AGE:- SEX:---RACE:ADDRESS:- ADDRESS:POST OFFICE:--- ZIP:OCCUPATION: - RESIDENT OF(Please
check appropriate boxes below:) ELECTED OFFICIAL () INCOME: Below $5,000 ()
$10,000-$15,000 « ()
Over $20,000 2/3
CITIZEN ()
$5,000-$10,000 ( )
$15,000-$20,000 ()
()
90.5%