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I
FORM 1045
D
REV. 1-2-35
THE AMERICAN RED CROSS
S
NATIONAL HEADQUARTERS
WASHINGTON, D. c.
a
QUESTIONNAMRES DESTRUYED
8/27/15
e
14
"
4
Dear Madam:
The National Committee on Red Cross Nursing Service requires us to submit,
annually, a report of all the Red Cross Nurses enrolled with our Committee. Will you
therefore, please answer the following questions and return this form to me, in the
enclosed envelope, at the earliest possible date? THIS ANNUAL QUESTIONNAIRE IS FILED
WITH YOUR RECORDS AT NATIONAL HEADQUARTERS IN WASHINGTON, D. C. We hope you will rec-
ognize the value of filing this information and will return the questionnaire promptly,
as we are extremely anxious to make a very complete report to National Headquarters.
IMPORTANT:
Yours sincerely,
In order to render prompt service
Chairman or
in time of disaster, enrolled Red Cross
Lorraine Knight
Secretary.
Nurses should report at once to the
Secretary of the Local Committee under
Secretary
Local Committee.
which they are enrolled. Do not forget
the address of the Secretary.
Name in full
Angeliea Peale Didier
It ) orth . Jejas. City Co Hospital
If married, give husband's name
Permanent address 1212.Lo. InsuralizSt. Fatwort Tatfant Teras .
(STREET, ETC.)
(CITY)
(COUNTY)
(STATE)
Probable address for the next year Sewar
(STREET, ETC.)
Telephone No. 2.7191
(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)
W²LM. Brrou. 1651- 31 St St.n.w. loashing too D.C. (Sister)
Underline the type of work you are now doing:
Army - Navy - U.S.P.H. Service - Veterans 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?
Have you ever been? no.
Indicate present physical condition good
Would you respond to an emergency call in event of epidemic, disaster, war, etc.? Yes
Badge No. 5995
Current date March. 114-1938
a
NOTE. -If the nurse does not complete and return this questionnaire, and can not be
a
located within two years, her enrolment will be removed from our active files.
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"ocrText": "I\nFORM 1045\nD\nREV. 1-2-35\nTHE AMERICAN RED CROSS\nS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. c.\na\nQUESTIONNAMRES DESTRUYED\n8/27/15\ne\n14\n\"\n4\nDear Madam:\nThe National Committee on Red Cross Nursing Service requires us to submit,\nannually, a report of all the Red Cross Nurses enrolled with our Committee. Will you\ntherefore, please answer the following questions and return this form to me, in the\nenclosed envelope, at the earliest possible date? THIS ANNUAL QUESTIONNAIRE IS FILED\nWITH YOUR RECORDS AT NATIONAL HEADQUARTERS IN WASHINGTON, D. C. We hope you will rec-\nognize the value of filing this information and will return the questionnaire promptly,\nas we are extremely anxious to make a very complete report to National Headquarters.\nIMPORTANT:\nYours sincerely,\nIn order to render prompt service\nChairman or\nin time of disaster, enrolled Red Cross\nLorraine Knight\nSecretary.\nNurses should report at once to the\nSecretary of the Local Committee under\nSecretary\nLocal Committee.\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nName in full\nAngeliea Peale Didier\nIt ) orth . Jejas. City Co Hospital\nIf married, give husband's name\nPermanent address 1212.Lo. InsuralizSt. Fatwort Tatfant Teras .\n(STREET, ETC.)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address for the next year Sewar\n(STREET, ETC.)\nTelephone No. 2.7191\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)\nW²LM. Brrou. 1651- 31 St St.n.w. loashing too D.C. (Sister)\nUnderline the type of work you are now doing:\nArmy - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service\n-\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?\nHave you ever been? no.\nIndicate present physical condition good\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.? Yes\nBadge No. 5995\nCurrent date March. 114-1938\na\nNOTE. -If the nurse does not complete and return this questionnaire, and can not be\na\nlocated within two years, her enrolment will be removed from our active files."
}