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FORM 1045
REV. DEC. 1939
AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. C.
Name in full
LEPRESTRE Genevieve "Gee
(SURNAME)
(FIRST)
(MIDDLE)
Husband's name
Permanent address 2334 N. W. Northrup Portland over
(STREET)
(CITY)
(COUNTY) multional
(STATE)
county-
Probable address
for the next year
sauce
(STREET)
(CITY)
(COUNTY)
(STATE)
Telephone number
Be 8217-
(EXCHANGE)
(NO.)
Nearest relative or friend in United States, through whom you may be communicated with in
an
emergency: Rene Seprestive
Father
(NAME)
(RELATIONSHIP)
310 Riverside (STREET) Drive New (CITY) York City (STATE) N.Y.
PRESENT WORK (check below)
Name of agency or institution with which employed
Institutional
st Vincents Hospital
Public Health
Private duty
Other (write in)
Government Service: Army
U.S.P.H.Service
Veterans Administration
Navy
U.S. Indian Service
Children's Bureau
IF NOT ACTIVE IN NURSING check field of nursing with which you are most familiar:
Institutional
Public Health
Private duty
Other (write in)
Would you respond to an emergency call in event of local or national emergency, such as
epidemic, flood, war, etc.
(Granted of course that you could be released from present employment)
yrs
Present physical condition good
Would you be interested in teaching classes in Home Hygiene and Care of the Sick?
Are you member of the American Nurses' Association? yes
a
If not, why have you allowed your membership to lapse? no
Badge No. 62545
Current date 8-16-40-
Name of Committee
Oragon State & Local
Note: If a nurse does not complete and return this questionnaire, and cannot be located
within two years, her enroilment will be removed from our active files.
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"ocrText": "FORM 1045\nREV. DEC. 1939\nAMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\nName in full\nLEPRESTRE Genevieve \"Gee\n(SURNAME)\n(FIRST)\n(MIDDLE)\nHusband's name\nPermanent address 2334 N. W. Northrup Portland over\n(STREET)\n(CITY)\n(COUNTY) multional\n(STATE)\ncounty-\nProbable address\nfor the next year\nsauce\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nTelephone number\nBe 8217-\n(EXCHANGE)\n(NO.)\nNearest relative or friend in United States, through whom you may be communicated with in\nan\nemergency: Rene Seprestive\nFather\n(NAME)\n(RELATIONSHIP)\n310 Riverside (STREET) Drive New (CITY) York City (STATE) N.Y.\nPRESENT WORK (check below)\nName of agency or institution with which employed\nInstitutional\nst Vincents Hospital\nPublic Health\nPrivate duty\nOther (write in)\nGovernment Service: Army\nU.S.P.H.Service\nVeterans Administration\nNavy\nU.S. Indian Service\nChildren's Bureau\nIF NOT ACTIVE IN NURSING check field of nursing with which you are most familiar:\nInstitutional\nPublic Health\nPrivate duty\nOther (write in)\nWould you respond to an emergency call in event of local or national emergency, such as\nepidemic, flood, war, etc.\n(Granted of course that you could be released from present employment)\nyrs\nPresent physical condition good\nWould you be interested in teaching classes in Home Hygiene and Care of the Sick?\nAre you member of the American Nurses' Association? yes\na\nIf not, why have you allowed your membership to lapse? no\nBadge No. 62545\nCurrent date 8-16-40-\nName of Committee\nOragon State & Local\nNote: If a nurse does not complete and return this questionnaire, and cannot be located\nwithin two years, her enroilment will be removed from our active files."
}