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FORM 1045
REV. 12-3-37
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. c.
+
0 QUESTIONNAIRES DESTROYED
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
E Pearson
Chairman or
Nurses should report at once to the
Secretary.
Secretary of the Local Committee under
Luismile
which they are enrolled. Do not forget
Local Committee.
the address of the Secretary.
Name in full
Ruth Lauton
If married, give husband's name
Permanent address
meravian Falls, Wilked north Carolina
(STREET, ETC.)
(CITY)
(COUNTY)
(STATE)
Probable address for the next year Christian Century Chapter, american Red Crace,
(STREET, ETC,
Telephone No.
53
Hofkinsville, (CITY) Christian (COUNTY) Kentucky (STATE)
Name and address of nearest relative or friend, in United States, through whom you may
be communicated with in an emergency. (State relationship)
Layton, mother, maria Falls, narth Carolina
Underline the type of work you are now doing:
Army - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service -
I
Public Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar.
Are an classes in
you instructor of Red Cross Home Hygiene and Care of the Sick? yes
D.
Have you ever been?
Indicate present physical condition Bood
Would you respond to an emergency call in event of repidemic, disaster, war, etc.? yes
U
Badge No Home Depense
Current date February 3, 1938
2
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": "FORM 1045\nREV. 12-3-37\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. c.\n+\n0 QUESTIONNAIRES DESTROYED\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\nE Pearson\nChairman or\nNurses should report at once to the\nSecretary.\nSecretary of the Local Committee under\nLuismile\nwhich they are enrolled. Do not forget\nLocal Committee.\nthe address of the Secretary.\nName in full\nRuth Lauton\nIf married, give husband's name\nPermanent address\nmeravian Falls, Wilked north Carolina\n(STREET, ETC.)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address for the next year Christian Century Chapter, american Red Crace,\n(STREET, ETC,\nTelephone No.\n53\nHofkinsville, (CITY) Christian (COUNTY) Kentucky (STATE)\nName and address of nearest relative or friend, in United States, through whom you may\nbe communicated with in an emergency. (State relationship)\nLayton, mother, maria Falls, narth Carolina\nUnderline the type of work you are now doing:\nArmy - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service -\nI\nPublic Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar.\nAre an classes in\nyou instructor of Red Cross Home Hygiene and Care of the Sick? yes\nD.\nHave you ever been?\nIndicate present physical condition Bood\nWould you respond to an emergency call in event of repidemic, disaster, war, etc.? yes\nU\nBadge No Home Depense\nCurrent date February 3, 1938\n2\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."
}