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FORM 1045 REV. 2-16-31
NATIONAL OFFICERS
CENTRAL COMMITTEE
FRANKLIN D. ROOSEVELT, PRESIDENT
JOHN BARTON PAYNE, CHAIRMAN
CHARLES EVANS HUGHES, VICE PRESIDENT
HERBERT HOOVER, VICE PRESIDENT
THE AMERICAN RED CROSS
ARTHUR A. BALLANTINE
MRS. AUGUST BELMONT
THOMAS D. THACHER, COUNSELOR
CORNELIUS N. BLISS
ARTHUR A. BALLANTINE, TREASURER
NATIONAL HEADQUARTERS
MABEL T. BOARDMAN
MRS. HENRY P. DAVISON
MABEL T. BOARDMAN, SECRETARY
WASHINGTON, D. c.
WILLIAM FORTUNE
SAMUEL KNIGHT
MAJ. GEN. ROBERT u. PATTERSON
NATIONAL EXECUTIVE OFFICERS
WILLIAM PHILLIPS
AAr ROOM
GUSTAVUS D. POPE
JOHN BARTON PAYNE, CHAIRMAN
MRS. HENRY R. REA
JAMES L. FIESER, VICE CHAIRMAN
REAR ADMIRAL PERCEVAL s. ROSSITER
ERNEST P. BICKNELL. VICE CHAIRMAN
GEORGE E. SCOTT
JAMES K. Mcclintock, VICE CHAIRMAN
HENRY UPSON SIMS
FEB 15 1934
ALFRED E. SMITH
THOMAS D. THACHER
ELIOT WADSWORTH
Referrad
H
Dear Madam:
S
The National Committee on Red Cross Nursing Service requires us to submit,
annually, a list of all the Red Cross Nurses enrolled with our Committee with their
latest addresses. We are extremely anxious to make a very complete report to National
Headquarters and ask for your cooperation. Please answer the following questions and
return this form to me, in the enclosed envelope, at the earliest possible date?
IMPORTANT:
In order to render prompt service
Yours sincerely,
in time of disaster, enrolled Red Cross
Nurses should report at once to the
Victoria Libriel
Chairman or
Secretary.
Secretary of the Local Committee under
which they are enrolled. Do not forget
a
hatesbury Comes
Local Committee.
the address of the Secretary.
Name in full
T.Jude along
If married, give husband name
Permanent
address Peonart Valley Come .
(STREET, ETC.)
(CITY)
(COUNTY)
(STATE)
-
Probable address for the next year
(STREET, ETC.)
Telephone No. 1192 -4 to inster
Come
(CITY)
(COUNTY)
(STATE)
Name and address of nearest relative or friend, in United States, through whom "you may
be communicated with in an emergency. (State relationship)
Underline the type of work you are now doing:
Seater) mrs William 9 Rechardson 101 10/Safey wellow Brooklyn
my
Army - Navy - U.S.P.H. Service - U.S. Vet. Administration - U.S. Indian Service -
Public Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar.
Are you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? to
Have you ever been?
yes c
Indicate present physical condition good
Would you respond to an emergency call in event of epidemic, disaster, war, etc.
?
yes.
Badge No. 105
Current date teb8" 1934
NOTE. - If the nurse does not complete and return this questionnaire, and can not be
located within two years, her enrolment may be annulled.
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"ocrText": "D\nFORM 1045 REV. 2-16-31\nNATIONAL OFFICERS\nCENTRAL COMMITTEE\nFRANKLIN D. ROOSEVELT, PRESIDENT\nJOHN BARTON PAYNE, CHAIRMAN\nCHARLES EVANS HUGHES, VICE PRESIDENT\nHERBERT HOOVER, VICE PRESIDENT\nTHE AMERICAN RED CROSS\nARTHUR A. BALLANTINE\nMRS. AUGUST BELMONT\nTHOMAS D. THACHER, COUNSELOR\nCORNELIUS N. BLISS\nARTHUR A. BALLANTINE, TREASURER\nNATIONAL HEADQUARTERS\nMABEL T. BOARDMAN\nMRS. HENRY P. DAVISON\nMABEL T. BOARDMAN, SECRETARY\nWASHINGTON, D. c.\nWILLIAM FORTUNE\nSAMUEL KNIGHT\nMAJ. GEN. ROBERT u. PATTERSON\nNATIONAL EXECUTIVE OFFICERS\nWILLIAM PHILLIPS\nAAr ROOM\nGUSTAVUS D. POPE\nJOHN BARTON PAYNE, CHAIRMAN\nMRS. HENRY R. REA\nJAMES L. FIESER, VICE CHAIRMAN\nREAR ADMIRAL PERCEVAL s. ROSSITER\nERNEST P. BICKNELL. VICE CHAIRMAN\nGEORGE E. SCOTT\nJAMES K. Mcclintock, VICE CHAIRMAN\nHENRY UPSON SIMS\nFEB 15 1934\nALFRED E. SMITH\nTHOMAS D. THACHER\nELIOT WADSWORTH\nReferrad\nH\nDear Madam:\nS\nThe National Committee on Red Cross Nursing Service requires us to submit,\nannually, a list of all the Red Cross Nurses enrolled with our Committee with their\nlatest addresses. We are extremely anxious to make a very complete report to National\nHeadquarters and ask for your cooperation. Please answer the following questions and\nreturn this form to me, in the enclosed envelope, at the earliest possible date?\nIMPORTANT:\nIn order to render prompt service\nYours sincerely,\nin time of disaster, enrolled Red Cross\nNurses should report at once to the\nVictoria Libriel\nChairman or\nSecretary.\nSecretary of the Local Committee under\nwhich they are enrolled. Do not forget\na\nhatesbury Comes\nLocal Committee.\nthe address of the Secretary.\nName in full\nT.Jude along\nIf married, give husband name\nPermanent\naddress Peonart Valley Come .\n(STREET, ETC.)\n(CITY)\n(COUNTY)\n(STATE)\n-\nProbable address for the next year\n(STREET, ETC.)\nTelephone No. 1192 -4 to inster\nCome\n(CITY)\n(COUNTY)\n(STATE)\nName and address of nearest relative or friend, in United States, through whom \"you may\nbe communicated with in an emergency. (State relationship)\nUnderline the type of work you are now doing:\nSeater) mrs William 9 Rechardson 101 10/Safey wellow Brooklyn\nmy\nArmy - Navy - U.S.P.H. Service - U.S. Vet. Administration - U.S. Indian Service -\nPublic Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar.\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? to\nHave you ever been?\nyes c\nIndicate present physical condition good\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.\n?\nyes.\nBadge No. 105\nCurrent date teb8\" 1934\nNOTE. - If the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrolment may be annulled."
}