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I
(6
PORM 1045-B
S
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
a
WASHINGTON, D. C.
I FB
Management
JAN 8 1936
C.
Dear Madam:
The National Committee on Red Cross Nursing Service requires us to submit,
annually, a list of all enrolled Red Cross Nurses with their latest addresses. We are
extremely anxious to make a very complete report and ask for your cooperation. Will
you kindly answer the following questions and return this form to me, in the enclosed
envelope, at the earliest possible date?
Yours sincerely,
Class D. roges
National Director,
Red Cross Nursing Service
Name in
full Susan
If married, give husband's name
Permanent address 3424 Simpsons Sl. montreal 11 P.2.
Probable address for the next year IL
n
Canada
Name and address of nearest relative or friend, in United States, through whom you may
be communicated with in an emergency. (State relationship)
Indicate the type of work
you are now doing:
home
Are you an instructor of Red Cross classes
in Home Hygiene and Care of the Sick? ho
Have you ever been?
ges
Indicate present physical condition
Bor
Would you respond to an emergency call in event epidemic,
of disaster, war, etc.? no
Badge No. 1579.
Current date Tebe 10 - 1986
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": "I\n(6\nPORM 1045-B\nS\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\na\nWASHINGTON, D. C.\nI FB\nManagement\nJAN 8 1936\nC.\nDear Madam:\nThe National Committee on Red Cross Nursing Service requires us to submit,\nannually, a list of all enrolled Red Cross Nurses with their latest addresses. We are\nextremely anxious to make a very complete report and ask for your cooperation. Will\nyou kindly answer the following questions and return this form to me, in the enclosed\nenvelope, at the earliest possible date?\nYours sincerely,\nClass D. roges\nNational Director,\nRed Cross Nursing Service\nName in\nfull Susan\nIf married, give husband's name\nPermanent address 3424 Simpsons Sl. montreal 11 P.2.\nProbable address for the next year IL\nn\nCanada\nName and address of nearest relative or friend, in United States, through whom you may\nbe communicated with in an emergency. (State relationship)\nIndicate the type of work\nyou are now doing:\nhome\nAre you an instructor of Red Cross classes\nin Home Hygiene and Care of the Sick? ho\nHave you ever been?\nges\nIndicate present physical condition\nBor\nWould you respond to an emergency call in event epidemic,\nof disaster, war, etc.? no\nBadge No. 1579.\nCurrent date Tebe 10 - 1986\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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