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B I a officially FORM 1045 REV. 1-2-35 THE AMERICAN RED CROSS I NATIONAL HEADQUARTERS Z (b WASHINGTON, D. c. + le 5 -I POTROYED R C Dear Madam: s - 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 5 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 Secretary. Nurses should report at once to the Secretary of the Local Committee under Buffals. Local Committee. which they are enrolled. Do not forget the address of the Secretary. Name in full Helew R. Haybons. If married, give husband's name Permanent address 15 18 abbort R. KTC.) Buffalo (CITY Eril (COUNTY) my (STREET, (STATE) Probable next address for the year 1518 abbott (STREET Rd. (GTC.) Buffalol D. Telephone No. ab.6236 Buffalo Erie (COUNTY) n.y. CETATE) Name and address of nearest relative or friend, in United States, through whom you may be communicated with in an emergency. (State relationship) Underline many the Devine- type of work 1518 you are abbort now doing: Rd. Buffalo. my - friend 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? no 5 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. 59,896 Current date 2/1/38 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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    "ocrText": "B\nI\na\nofficially\nFORM 1045\nREV. 1-2-35\nTHE AMERICAN RED CROSS\nI\nNATIONAL HEADQUARTERS\nZ\n(b\nWASHINGTON, D. c.\n+\nle\n5\n-I POTROYED\nR\nC\nDear Madam:\ns\n-\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\n5\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\nSecretary.\nNurses should report at once to the\nSecretary of the Local Committee under\nBuffals.\nLocal Committee.\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nName in full\nHelew R. Haybons.\nIf married, give husband's name\nPermanent address 15 18 abbort R. KTC.) Buffalo (CITY\nEril\n(COUNTY)\nmy\n(STREET,\n(STATE)\nProbable next\naddress for the year 1518 abbott (STREET Rd. (GTC.) Buffalol D.\nTelephone No. ab.6236\nBuffalo\nErie\n(COUNTY)\nn.y.\nCETATE)\nName and address of nearest relative or friend, in United States, through whom you may\nbe communicated with in an emergency. (State relationship)\nUnderline\nmany the Devine- type of work 1518 you are abbort now doing: Rd. Buffalo. my - friend\nArmy - Navy - U.S.P.H. Service - Veterans 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? no\n5\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. 59,896\nCurrent date\n2/1/38\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."
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