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II
N
FORM 1045
Mani
M
REV. 4-4-38
THE AMERICAN RED CROSS
rs.
T
NATIONAL HEADQUARTERS
WASHINGTON, D. C.
2.
2
N
D
an
ur
5
Dear Red Cross Nurse:
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:
In order to render prompt service
Yours sincerely,
Chairman or
in time of disaster, enrolled Red Cross
Jessie Greathouse
Nurses should report at once to the
Secretary.
Secretary of the Local Committee under
Lexington, Ky.
Local Committee.
which they are enrolled. Do not forget
the address of the Secretary.
Name in full
Mrs Namine Amelia Cap Hane
If married, give husband's name
Permanent address Blue cullege Host Berea (CITY)
madison
(STREET, RTC.)
(COUNTY)
kentucky (STATE)
Probable address for the next year same as alone
(STREET, ETC.)
Telephone No.
8
Berea
madison
(CITY)
(COUNTY)
by
(STATE)
Name and address of nearest relative or friend, in United States, through whom you may
be communicated with in an emergency. (State relationship)
Mrs. games m. Cax (mother) fort Blochmore, Virgania
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.
ho
Are you an instructor of Red Cross classes in Home Hygiene and Care of the Sick?
Have you ever been?
yes
Would you like to teach Red Cross classes? of time
Indicate present physical condition becoring am Igbining from Auto accident hot good,
Would you respond to an emergency call in event of epidemic, disaster, war, etc.? yes
Badge No. 40376
Current date Tel-26,1940
NOTE. -If the nurse does not complete and return this questionnaire, and can not be
located within two years, her enrolment will be removed from our active files.
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- photo
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Document data
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- Core
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- Type
- document
DTO data
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"ocrText": "II\nN\nFORM 1045\nMani\nM\nREV. 4-4-38\nTHE AMERICAN RED CROSS\nrs.\nT\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\n2.\n2\nN\nD\nan\nur\n5\nDear Red Cross Nurse:\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:\nIn order to render prompt service\nYours sincerely,\nChairman or\nin time of disaster, enrolled Red Cross\nJessie Greathouse\nNurses should report at once to the\nSecretary.\nSecretary of the Local Committee under\nLexington, Ky.\nLocal Committee.\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nName in full\nMrs Namine Amelia Cap Hane\nIf married, give husband's name\nPermanent address Blue cullege Host Berea (CITY)\nmadison\n(STREET, RTC.)\n(COUNTY)\nkentucky (STATE)\nProbable address for the next year same as alone\n(STREET, ETC.)\nTelephone No.\n8\nBerea\nmadison\n(CITY)\n(COUNTY)\nby\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)\nMrs. games m. Cax (mother) fort Blochmore, Virgania\nUnderline the type of work you are now doing:\nArmy - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service -\nPublic Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar.\nho\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick?\nHave you ever been?\nyes\nWould you like to teach Red Cross classes? of time\nIndicate present physical condition becoring am Igbining from Auto accident hot good,\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.? yes\nBadge No. 40376\nCurrent date Tel-26,1940\nNOTE. -If the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrolment will be removed from our active files."
}