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FORM 104S-A
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REV. 12:3-37
A. R. C. MAIL ROOM
THE AMERICAN RED CROSS
RECEIVED
NATIONAL HEADQUARTERS
WASHINGTON, D. C.
ts,
M
FEB 10 1938
Referred To
FEB 1 1938
Z
M
2 QUESTIONNAIRES DESTROYED
Dear Red Cross Nurse:
Z
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
u
extremely anxious to make a very complete report and ask for your cooperation. Will
1
you kindly answer the following questions and return this form to me, in the enclosed
s
envelope, at the earliest possible date?
e
Yours sincerely,
IMPORTANT:
In order to render prompt service
in time of disaster, enrolled Red Cross
Ida 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
Myn M.Hoffman Superintendent Havy Nurse Carps
If married, give husband's name
Permanent address
2145 "C"Street, N.W.
Washington, D.C.
(STREET, ETC.)
(CITY)
(COUNTY)
(STATE)
Same as above
Probable address for the next year
(STREET, ETC.)
Telephone No. national 5848
(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 Jane Peterson, Bradford Illinois
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?
Have you ever been?
Indicate present physical condition Have been under treatment for duodenal ulcer-recovery
I
not yet complete
Would you respond to an emergency call in event of epidemic, disaster, war, etc.
Badge
No. H.D.
Current date
strucky 8,1938
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": "N I\na\n0\n+\n-\nff\nJ\nn\nI\na\nFORM 104S-A\na\nn\nREV. 12:3-37\nA. R. C. MAIL ROOM\nTHE AMERICAN RED CROSS\nRECEIVED\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\nts,\nM\nFEB 10 1938\nReferred To\nFEB 1 1938\nZ\nM\n2 QUESTIONNAIRES DESTROYED\nDear Red Cross Nurse:\nZ\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\nu\nextremely anxious to make a very complete report and ask for your cooperation. Will\n1\nyou kindly answer the following questions and return this form to me, in the enclosed\ns\nenvelope, at the earliest possible date?\ne\nYours sincerely,\nIMPORTANT:\nIn order to render prompt service\nin time of disaster, enrolled Red Cross\nIda 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\nMyn M.Hoffman Superintendent Havy Nurse Carps\nIf married, give husband's name\nPermanent address\n2145 \"C\"Street, N.W.\nWashington, D.C.\n(STREET, ETC.)\n(CITY)\n(COUNTY)\n(STATE)\nSame as above\nProbable address for the next year\n(STREET, ETC.)\nTelephone No. national 5848\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 Jane Peterson, Bradford Illinois\nUnderline the type of work you are now doing:\nArmy Navy U.S.P.H. Service - Veterans Administration - U.S. Indian Service\n-\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?\nHave you ever been?\nIndicate present physical condition Have been under treatment for duodenal ulcer-recovery\nI\nnot yet complete\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.\nBadge\nNo. H.D.\nCurrent date\nstrucky 8,1938\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."
}