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FORM 1045 REV. 2-16-31
NATIONAL OFFICERS
CENTRAL COMMITTEE
HERBERT HOOVER, PRESIDENT
JOHN BARTON PAYNE, CHAIRMAN
ROBERT w. DE FOREST, VICE PRESIDENT
MRS. AUGUST BELMONT
CALVIN COOLIDGE, VICE PRESIDENT
THE AMERICAN RED CROSS
CORNELIUS N. BLISS
MABEL T. BOARDMAN
CHARLES EVANS HUGHES, VICE PRESIDENT
JOSEPH P COTTON
TROMAS D. THACHER, COUNSELOR
NATIONAL HEADQUARTERS
MRS. HENRY P. DAVISON
OGDEN L. MILLS, TREASURER
MRS. FRANK v. HAMMAR
MABEL T. BOARDMAN, SECRETARY
WASHINGTON, D.C.
MAJ. GEN. M. w. IRELAND
SAMUEL KNIGHT
OGDEN L. MILLS
NATIONAL EXECUTIVE OFFICERS
GUSTAVUS D. POPE
MRS, HENRY . REA
JOHN BARTON PAYNE, CHAIRMAN
REAR ADMIRAL CHARLES E. RIGGS
JAMES L. FIESER, VICE CHAIRMAN
JOHN D. RYAN
GEORGE E. SCOTT
ERNEST P. BICKNELL, VICE CHAIRMAN
HENRY UPSON SIMS
JAMES K. Mcclintock, VICE CHAIRMAN
THOMAS D. THACHER
ELIOT WADSWORTH
B
Dear Madam:
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 enclosed envelope, at the earliest possible date.
IMPORTANT:
In order to render prompt service
Yours sincerely,
in time of disaster, enrolled Red Cross
Carolyn Schmoker Chairman Secretary.
or
Nurses should report at once to the
Secretary of the Local Committee under
which they are enrolled. Do not forget
Local
Committee.
the address of the Secretary.
Name
in full miss alice B.P Conover
If married, give husband's name
Permanent address 7 Hillside are Summist Union
STREET, ETC.
CITY
COUNTY
Ang 1 STATE
Probable address for the next year Some
STREET, ETC.
Telephone No. 6-0055-W.
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 Reo 7.Ch. Conover Bernardeville h go
the type of work
you are now doing: Army - Navy - U.S.P.H. Hospital - U.S. Vet. Hospital - U.S. Indian
Registrar. Retired
Service - Public Hoalth - Institutional - Private Duty - Industrial - Office Nurse -
Are you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? no
Have you ever been?
no
Indicate present physical condition not LO good (age 67 in may)
Would you respond to an emergency call in event of epidemic, disaster, war, etc.?
Badge No. 12319
Current date Fet 5.th 1932
3
NOTE. -- If the nurse does not complete and return this questionnaire, and can not be
located within two years, her enrolment will be annulled.
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"ocrText": "FORM 1045 REV. 2-16-31\nNATIONAL OFFICERS\nCENTRAL COMMITTEE\nHERBERT HOOVER, PRESIDENT\nJOHN BARTON PAYNE, CHAIRMAN\nROBERT w. DE FOREST, VICE PRESIDENT\nMRS. AUGUST BELMONT\nCALVIN COOLIDGE, VICE PRESIDENT\nTHE AMERICAN RED CROSS\nCORNELIUS N. BLISS\nMABEL T. BOARDMAN\nCHARLES EVANS HUGHES, VICE PRESIDENT\nJOSEPH P COTTON\nTROMAS D. THACHER, COUNSELOR\nNATIONAL HEADQUARTERS\nMRS. HENRY P. DAVISON\nOGDEN L. MILLS, TREASURER\nMRS. FRANK v. HAMMAR\nMABEL T. BOARDMAN, SECRETARY\nWASHINGTON, D.C.\nMAJ. GEN. M. w. IRELAND\nSAMUEL KNIGHT\nOGDEN L. MILLS\nNATIONAL EXECUTIVE OFFICERS\nGUSTAVUS D. POPE\nMRS, HENRY . REA\nJOHN BARTON PAYNE, CHAIRMAN\nREAR ADMIRAL CHARLES E. RIGGS\nJAMES L. FIESER, VICE CHAIRMAN\nJOHN D. RYAN\nGEORGE E. SCOTT\nERNEST P. BICKNELL, VICE CHAIRMAN\nHENRY UPSON SIMS\nJAMES K. Mcclintock, VICE CHAIRMAN\nTHOMAS D. THACHER\nELIOT WADSWORTH\nB\nDear Madam:\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 enclosed envelope, at the earliest possible date.\nIMPORTANT:\nIn order to render prompt service\nYours sincerely,\nin time of disaster, enrolled Red Cross\nCarolyn Schmoker Chairman Secretary.\nor\nNurses should report at once to the\nSecretary of the Local Committee under\nwhich they are enrolled. Do not forget\nLocal\nCommittee.\nthe address of the Secretary.\nName\nin full miss alice B.P Conover\nIf married, give husband's name\nPermanent address 7 Hillside are Summist Union\nSTREET, ETC.\nCITY\nCOUNTY\nAng 1 STATE\nProbable address for the next year Some\nSTREET, ETC.\nTelephone No. 6-0055-W.\nCITY\nCOUNTY\nSTATE\nName and address of nearest relative or friend, in United States, through whom you may\nbe communicated with in an emergency. (State relationship)\nUnderline Reo 7.Ch. Conover Bernardeville h go\nthe type of work\nyou are now doing: Army - Navy - U.S.P.H. Hospital - U.S. Vet. Hospital - U.S. Indian\nRegistrar. Retired\nService - Public Hoalth - Institutional - Private Duty - Industrial - Office Nurse -\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? no\nHave you ever been?\nno\nIndicate present physical condition not LO good (age 67 in may)\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.?\nBadge No. 12319\nCurrent date Fet 5.th 1932\n3\nNOTE. -- If the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrolment will be annulled."
}