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Form 1045
NATIONAL OFFICERS
CENTRAL COMMITTEE
GALVIN COOLIDGE. PRESIDENT
JOHN BARTON PAYNE, CHAIRMAN
MRS. AUGUST BELMONT
ROBERT w. DE FOREST, VICE PRESIDENT
CORNELIUS N. BLISS
WILLIAM HOWARD TAFT, VICE PRESIDENT
THE AMERICAN RED CROSS
MABEL T. BOARDMAN
0
WILLIAM D. MITCHELL, COUNSELOR
MRS, HENRY P. DAVISON
E, B. DOUGLAS
GARDARD B. WINSTON, TREASURER
NATIONAL HEADQUARTERS
JOSEPH c. GREW
MABEL T. BOARDMAN. SECRETARY
MRS. FRANK v. HAMMAR
WASHINGTON, D.C.
HERBERT HOOVER
in
MAJ. GEN. M. W.IRELAND
NATIONAL EXECUTIVE OFFICERS
WILLIAM D. MITCHELL
w. w. MORROW
s
JOHN BARTON PAYNE, CHAIRMAN
GUSTAVUS D, POPE
MRS, HENRY R. REA
JAMES L. FIESER, VICE CHAIRMAN
JOHN D. RYAN
ERNEST P. BICKNELL. VICE CHAIRMAN
GEORGE E. SCOTT
REAR ADMIRAL E, R. STITT
GARRARD B. WINSTON
M
Dear Madam:
As you undoubtedly know, the National Committee on Red Cross Nursing Service
requires us to submit, annually, a list of all the Red Cross Nurses enrolled with our
Committee, with their latest addresses. We know that you are very busy, but we are
extremely anxious to make a very complete report to National Headquarters and ask for
your
cooperation. Please answer the following questions and return this form to me,
in the enclosed envelope, at the earliest possible date.
Yours sincerely,
Chairman or
Olive M. Diederich, R.N.
Secretary.
2157 Euclid Avenue
Cleveland, 0.
Local Committee.
Name in
full Lince m Pourll
If married, give husband's name
Permanent address 8907 Carrejie are Clereland this
Probable address for the next year
same
Telephone No. Cedar 3360
Name and address of nearest relative Tucy Leen Pmill (sister )
(State relationship)
sawe
Underline the type of work
you are now doing: - Army - Navy - U.S.P.H.Hospital - U.S.Vet.Hospital - Public
administ tratini Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar
Are you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? tho
Have you ever been?
no
Indicate present physical condition
Good
Would you respond to an emergency call in event of epidemic, disaster, war, etc. ? yes
Badge No. 4114
Current
date march 13.1926
NOTE.--If the nurse does not complete and return this questionnaire, and can not be
located within two years, her enrollment will be annulled.
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"ocrText": "e\nForm 1045\nNATIONAL OFFICERS\nCENTRAL COMMITTEE\nGALVIN COOLIDGE. PRESIDENT\nJOHN BARTON PAYNE, CHAIRMAN\nMRS. AUGUST BELMONT\nROBERT w. DE FOREST, VICE PRESIDENT\nCORNELIUS N. BLISS\nWILLIAM HOWARD TAFT, VICE PRESIDENT\nTHE AMERICAN RED CROSS\nMABEL T. BOARDMAN\n0\nWILLIAM D. MITCHELL, COUNSELOR\nMRS, HENRY P. DAVISON\nE, B. DOUGLAS\nGARDARD B. WINSTON, TREASURER\nNATIONAL HEADQUARTERS\nJOSEPH c. GREW\nMABEL T. BOARDMAN. SECRETARY\nMRS. FRANK v. HAMMAR\nWASHINGTON, D.C.\nHERBERT HOOVER\nin\nMAJ. GEN. M. W.IRELAND\nNATIONAL EXECUTIVE OFFICERS\nWILLIAM D. MITCHELL\nw. w. MORROW\ns\nJOHN BARTON PAYNE, CHAIRMAN\nGUSTAVUS D, POPE\nMRS, HENRY R. REA\nJAMES L. FIESER, VICE CHAIRMAN\nJOHN D. RYAN\nERNEST P. BICKNELL. VICE CHAIRMAN\nGEORGE E. SCOTT\nREAR ADMIRAL E, R. STITT\nGARRARD B. WINSTON\nM\nDear Madam:\nAs you undoubtedly know, the National Committee on Red Cross Nursing Service\nrequires us to submit, annually, a list of all the Red Cross Nurses enrolled with our\nCommittee, with their latest addresses. We know that you are very busy, but we are\nextremely anxious to make a very complete report to National Headquarters and ask for\nyour\ncooperation. Please answer the following questions and return this form to me,\nin the enclosed envelope, at the earliest possible date.\nYours sincerely,\nChairman or\nOlive M. Diederich, R.N.\nSecretary.\n2157 Euclid Avenue\nCleveland, 0.\nLocal Committee.\nName in\nfull Lince m Pourll\nIf married, give husband's name\nPermanent address 8907 Carrejie are Clereland this\nProbable address for the next year\nsame\nTelephone No. Cedar 3360\nName and address of nearest relative Tucy Leen Pmill (sister )\n(State relationship)\nsawe\nUnderline the type of work\nyou are now doing: - Army - Navy - U.S.P.H.Hospital - U.S.Vet.Hospital - Public\nadminist tratini Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? tho\nHave you ever been?\nno\nIndicate present physical condition\nGood\nWould you respond to an emergency call in event of epidemic, disaster, war, etc. ? yes\nBadge No. 4114\nCurrent\ndate march 13.1926\nNOTE.--If the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrollment will be annulled."
}