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FORM 1045
Chy
+
REV. 4-4-38
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. C.
MAR 51939
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
Nurses should report at once to the
HELEN E. HESTAD
440 SEXTEN BUILDING
Secretary.
Secretary of the Local Committee under
MINNEAPOLIS, MINN.
which they are enrolled. Do not forget
Local Committee.
the address of the Secretary.
Name in full
Petry Lucies
If married, give husband's name
Permanent address
Felton
Kent
Delaware
(STREET, ETC.)
(CITY)
(COUNTY)
(STATE)
Probable address for the next year
727-15th are S. mplo min
(STREET, ETC.)
Telephone No. ge 3877
mysels
Henny
(CITY)
(COUNTY)
Manager
(STATE)
Name and address of nearest relative or friend, in United States, through whom you may
be communicated with in an emergency. (State relationship)
m D A Petry (father) Felton Delaware
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.
Teaching
Are you an instructor of Red Cross classes in Home Hygiene and Care of the Sick?
Have you ever been?
Would you like to teach Red Cross classes?
Indicate present physical condition Ex clleut
Would you respond to an emergency call in event of epidemic, disaster, war, etc.? yes
Badge No.
50637
Current date Up -, 39
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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Document data
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"ocrText": "FORM 1045\nChy\n+\nREV. 4-4-38\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\nMAR 51939\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\nNurses should report at once to the\nHELEN E. HESTAD\n440 SEXTEN BUILDING\nSecretary.\nSecretary of the Local Committee under\nMINNEAPOLIS, MINN.\nwhich they are enrolled. Do not forget\nLocal Committee.\nthe address of the Secretary.\nName in full\nPetry Lucies\nIf married, give husband's name\nPermanent address\nFelton\nKent\nDelaware\n(STREET, ETC.)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address for the next year\n727-15th are S. mplo min\n(STREET, ETC.)\nTelephone No. ge 3877\nmysels\nHenny\n(CITY)\n(COUNTY)\nManager\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)\nm D A Petry (father) Felton Delaware\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.\nTeaching\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick?\nHave you ever been?\nWould you like to teach Red Cross classes?\nIndicate present physical condition Ex clleut\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.? yes\nBadge No.\n50637\nCurrent date Up -, 39\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."
}