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Lake, Alice E.

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+ FORM 1045 REV. 4-4-38 THE AMERICAN RED CROSS NATIONAL HEADQUARTERS WASHINGTON, D. C. 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, in time of disaster, enrolled Red Cross Chairman or F. M. Daggett Nurses should report at once to the Secretary. Peter Bent Brigham Hospital Secretary of the Local Committee under Boston, Mass, Local Committee. which they are enrolled. Do not forget the address of the Secretary. Name in full alice Lives Lake If married, give husband's name x Permanent address for Part (STREET, ETC.) Main Topifield (CITY) (COUNTY) Esex Mass (STATE) & Probable address for the next year 330 Brookline Ave, Boston Mass (STREET, ETC Telephone No. Beacon 4400 Boslor Tiffell mass (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) mother Mrs. Hora E. Lake Topsfield Wass. 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? he Have you ever been? yes Would you like to teach Red Cross classes? hot Indicate present physical condition Good Would you respond to an emergency call in event of epidemic, disaster, war, etc.? yes. Badge No. 6850 Current date apr 6, 1939. 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.

Page data

Page
9
Source index
0
Type
photo
Media ID
bac397993e628700
Size
unknown

Document data

ID
2661787
Core
doc
Type
document
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Context sent to Scholar

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Document source extras 
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    "coverageEndDate": {
        "day": 24,
        "logicalDate": "1940-03-24",
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        "day": 22,
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Page context 
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    "ocrText": "+\nFORM 1045\nREV. 4-4-38\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\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,\nin time of disaster, enrolled Red Cross\nChairman or\nF. M. Daggett\nNurses should report at once to the\nSecretary.\nPeter Bent Brigham Hospital\nSecretary of the Local Committee under\nBoston, Mass,\nLocal Committee.\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nName in full\nalice Lives Lake\nIf married, give husband's name\nx\nPermanent address for Part (STREET, ETC.) Main Topifield (CITY) (COUNTY) Esex Mass (STATE)\n&\nProbable address for the next year\n330 Brookline Ave, Boston Mass\n(STREET, ETC\nTelephone No. Beacon 4400\nBoslor\nTiffell\nmass\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)\nmother Mrs. Hora E. Lake Topsfield Wass.\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? he\nHave you ever been? yes Would you like to teach Red Cross classes? hot\nIndicate present physical condition Good\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.?\nyes.\nBadge No. 6850\nCurrent date apr 6, 1939.\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."
}