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FORM 1045
REV. 1-2-35
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. c.
Dear Madam:
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:
Yours sincerely,
In order to render prompt service
Chairman or
in time of disaster, enrolled Red Cross
Nurses should report at once to the
Dayton Ru Secretary.
Secretary of the Local Committee under
which they are enrolled. Do not forget
To youring state Local Committee.
the address of the Secretary.
662 So Lincolu. Caspe. wyouing
Name in full Valeria Rittenhouse R.n.
If married, give husband's name
Permanent address 4901 (STREET, Woodlawn Ave. ETC.) (CITY) Chicago
Illinois
(COUNTY)
(STATE)
Probable address for the next year University of (STREET Hyoring ETC.) Laramee
Telephone No. Branch 13-
(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)
Charles I Rittenhouse ,Cousin - 490 /. woodlawn Ave - Cheage
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? no
University nurse
Have you ever been?
no
Indicate present physical condition good
Would you to an call in event war,
respond emergency of epidemic, disaster, etc.? yes
Badge No. 10664
Current date March 4-1937
NOTE.--I 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": "+\nFORM 1045\nREV. 1-2-35\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. c.\nDear Madam:\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:\nYours sincerely,\nIn order to render prompt service\nChairman or\nin time of disaster, enrolled Red Cross\nNurses should report at once to the\nDayton Ru Secretary.\nSecretary of the Local Committee under\nwhich they are enrolled. Do not forget\nTo youring state Local Committee.\nthe address of the Secretary.\n662 So Lincolu. Caspe. wyouing\nName in full Valeria Rittenhouse R.n.\nIf married, give husband's name\nPermanent address 4901 (STREET, Woodlawn Ave. ETC.) (CITY) Chicago\nIllinois\n(COUNTY)\n(STATE)\nProbable address for the next year University of (STREET Hyoring ETC.) Laramee\nTelephone No. Branch 13-\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)\nCharles I Rittenhouse ,Cousin - 490 /. woodlawn Ave - Cheage\nUnderline the type of work you are now doing:\nArmy - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service\n-\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? no\nUniversity nurse\nHave you ever been?\nno\nIndicate present physical condition good\nWould you to an call in event war,\nrespond emergency of epidemic, disaster, etc.? yes\nBadge No. 10664\nCurrent date March 4-1937\nNOTE.--I 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."
}