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FORM 1045-A
REV. 1-15-35
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
M
WASHINGTON, D.C.
the C MARL ROOM
D
RECEIVED
5
APR 26 1937
APR 1 0 1937
n
Referged To
QUESTIONNAIRES DESTROYED
Missouring
a
Dear Madam:
C
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
a
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,
IMPORTANT:
In order to render prompt service
in time of disaster, enrolled Red Cross
Idu 7. Butter
Nurses should report at once to the
Secretary of the Local Committee under
National Director,
which they are enrolled. Do not forget
Red Cross Nursing Service
the address of the Secretary.
Name in full
anna Heisler
If married, give husband's name
Permanent address 204 Federal office Bldg, San Francisco, Calif.
(STREET, ETC.) ^(CITY)
(COUNTY)
(STATE)
Probable address for the next year
same as above
(STREET, ETC.)
Telephone No. market 3741, Ext. 240. San Francisco Calif.
(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)
sister Mrs. george a. Frey, 5643 Cherry, Kansas City Missouri.
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? No
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. 37509
Current date april 1937
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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- Core
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"ocrText": "I\nallerging\nFORM 1045-A\nREV. 1-15-35\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nM\nWASHINGTON, D.C.\nthe C MARL ROOM\nD\nRECEIVED\n5\nAPR 26 1937\nAPR 1 0 1937\nn\nReferged To\nQUESTIONNAIRES DESTROYED\nMissouring\na\nDear Madam:\nC\nThe National Committee on Red Cross Nursing Service requires us to submit,\nannually,\na list of all enrolled Red Cross Nurses with their latest addresses. We are\na\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,\nIMPORTANT:\nIn order to render prompt service\nin time of disaster, enrolled Red Cross\nIdu 7. Butter\nNurses should report at once to the\nSecretary of the Local Committee under\nNational Director,\nwhich they are enrolled. Do not forget\nRed Cross Nursing Service\nthe address of the Secretary.\nName in full\nanna Heisler\nIf married, give husband's name\nPermanent address 204 Federal office Bldg, San Francisco, Calif.\n(STREET, ETC.) ^(CITY)\n(COUNTY)\n(STATE)\nProbable address for the next year\nsame as above\n(STREET, ETC.)\nTelephone No. market 3741, Ext. 240. San Francisco Calif.\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)\nsister Mrs. george a. Frey, 5643 Cherry, Kansas City Missouri.\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.\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? No\nHave you ever been?\nNo\nIndicate present physical condition good\nWould you respond to an emergency call in event of epidemic, disaster, war, etc. ? yes\nBadge No. 37509\nCurrent date april 1937\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."
}