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Fl are RED CROSS BADGE NUMBER AMERICAN RED CROSS 2871, NURSING SERVICES MILITARY SERIAL NUMBER & 9 ANNUAL QUESTIONNAIRE - 1945 CHECK IF YOUR LAST NAME HAS CHANGED NAME (Last, first, middle) TELEPHONE NO. IF MARRIED, GIVE MAIDEN NAME Foerster, Alma Emma HUSBAND'S Badger 2017. D NAME - PERMANENT ADDRESS (Street, city, zone, county, state) 5946 N.E. Circle Ave., Chicago 31, Illinois { PRESENT ADDRESS (Street, city, zone, county, state) U.S.Veterans Administration, Mendota, Wis, a NAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES RELATIONSHIP Mvs. John 1 F. Dreyer. sister- Permanent Address about sister, DATE OF BIRTH (Month, day, year) Single Married Separated Jidowed Divorced July 25,1885 YES NO WHAT LANGUAGES DO YOU SPEAK? English and German, HIGH SCHOOL GRADUATE NAME OF COLLEGE OR DEGREE OR UNIVERSITY ATTENDED LOCATION INCLUSIVE DATES DIPLOMA MAJOR New YorkCity, N.4. 1925-1927 Junes Bachelor ARE YOU CURRENTLY YES NO REGISTERED IN (State) ARE YOU CURRENTLY A MEMBER OF THE AMERICAN YES NO REGISTERED? Wisconsing Illinois NURSES' ASSOCIATION? through Clume PRESENT EMPLOYMENT If not employed, check POSITION TITLE (H.N., P.D., inst. staff nurse, etc.) SERVICE (Medicine, surgery, etc.) staff Psychiatric NAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED CITY STATE visiveterans Adminis tration, Mendota, wis, HEALTH IF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY Good, 7 VOLUNTEER SERVICE The purpose of the following statements is to identify the nurses who can be counted upon to respond to a call to participate in a Red Cross chapter program. Please check the "Yes" box only if you are willing and able to serve if called on within the next 12 months. NAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS madison, Dane co., Wis, 1. Teach home YES NO Attend an instructors' training program, if offered. (Funds are available for YES NO nursing classes training home nursing instructors. See local chapter.) 2. Serve in case NO only in home community Attend disaster institutes, if YES NO YES In other communities offered, in preparation for service of disaster 4. Accept membership on chapter com- YES NO 5. Assist with other chapter YES NO 3. Teach nurse's YES NO mittee should services be needed programs, as needed aide classes If you have not answered "Yes" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that YES NO you will be able to serve at some time in the future? IF UNABLE TO SERVE, GIVE Present MAJOR REASONS position - in Hosfital-oundity - v.s. Veterans admosts. mendotar DATE S IGNATURE October 1,445. alma E, Foester, P.N., B.S. YOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR FAITHFOLNESS IN KEEPING US INFORMAD OF YOUR ADDRESS. PLEASE PILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY TO THE COMMITTEE NAMED BELOW. C ATTENTION Fill in committee name and address before sending questionnaire to nurse. SECRETARY Dane County Nurse Recruitment Committee NURSE RECRUITMENT 315 N. Carroll St. 11/2/15 COMMITTEE Madison, Wis. FORM 1045 Rev. July 1945 78504M

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    "ocrText": "Fl\nare\nRED CROSS BADGE NUMBER\nAMERICAN RED CROSS\n2871,\nNURSING SERVICES\nMILITARY SERIAL NUMBER\n&\n9\nANNUAL QUESTIONNAIRE - 1945\nCHECK IF YOUR LAST NAME HAS CHANGED\nNAME (Last, first, middle)\nTELEPHONE NO.\nIF MARRIED, GIVE MAIDEN NAME\nFoerster, Alma Emma HUSBAND'S\nBadger 2017.\nD\nNAME\n-\nPERMANENT ADDRESS (Street, city, zone, county, state)\n5946 N.E. Circle Ave., Chicago 31, Illinois\n{\nPRESENT ADDRESS (Street, city, zone, county, state)\nU.S.Veterans Administration, Mendota, Wis,\na\nNAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES\nRELATIONSHIP\nMvs. John 1 F. Dreyer. sister- Permanent Address about\nsister,\nDATE OF BIRTH (Month, day, year)\nSingle\nMarried\nSeparated\nJidowed\nDivorced\nJuly 25,1885\nYES\nNO\nWHAT LANGUAGES DO YOU SPEAK?\nEnglish and German,\nHIGH SCHOOL GRADUATE\nNAME OF COLLEGE OR\nDEGREE OR\nUNIVERSITY ATTENDED\nLOCATION\nINCLUSIVE DATES\nDIPLOMA\nMAJOR\nNew YorkCity, N.4. 1925-1927 Junes Bachelor\nARE YOU CURRENTLY\nYES\nNO\nREGISTERED IN (State)\nARE YOU CURRENTLY A MEMBER OF THE AMERICAN\nYES\nNO\nREGISTERED?\nWisconsing Illinois\nNURSES' ASSOCIATION? through Clume\nPRESENT EMPLOYMENT If not employed, check\nPOSITION TITLE (H.N., P.D., inst. staff nurse, etc.)\nSERVICE (Medicine, surgery, etc.)\nstaff\nPsychiatric\nNAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED\nCITY\nSTATE\nvisiveterans Adminis tration,\nMendota, wis,\nHEALTH\nIF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY\nGood,\n7\nVOLUNTEER SERVICE\nThe purpose of the following statements is to identify the nurses who can be counted upon to respond to a call\nto\nparticipate in a Red Cross chapter program. Please check the \"Yes\" box only if you are willing and able\nto\nserve if called on within the next 12 months.\nNAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS\nmadison, Dane co., Wis,\n1. Teach home\nYES\nNO\nAttend an instructors' training program, if offered. (Funds are available for\nYES\nNO\nnursing classes\ntraining home nursing instructors. See local chapter.)\n2. Serve in case\nNO\nonly in home community\nAttend disaster institutes, if\nYES\nNO\nYES\nIn other communities\noffered, in preparation for service\nof disaster\n4. Accept membership on chapter com-\nYES\nNO\n5. Assist with other chapter\nYES\nNO\n3. Teach nurse's\nYES\nNO\nmittee should services be needed\nprograms, as needed\naide classes\nIf you have not answered \"Yes\" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that\nYES\nNO\nyou will be able to serve at some time in the future?\nIF UNABLE TO SERVE, GIVE\nPresent MAJOR REASONS position - in Hosfital-oundity - v.s. Veterans admosts. mendotar\nDATE\nS IGNATURE\nOctober 1,445.\nalma E, Foester, P.N., B.S.\nYOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR FAITHFOLNESS\nIN\nKEEPING US INFORMAD OF YOUR ADDRESS. PLEASE PILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY TO THE\nCOMMITTEE NAMED BELOW.\nC\nATTENTION\nFill in committee name and address before sending questionnaire to nurse.\nSECRETARY\nDane County Nurse Recruitment Committee\nNURSE RECRUITMENT\n315 N. Carroll St.\n11/2/15\nCOMMITTEE\nMadison, Wis.\nFORM 1045 Rev. July 1945\n78504M"
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