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FORM 1045 REV. 1-7-30
NATIONAL OFFICERS
CENTRAL COMMITTEE
HERBERT HOOVER. PRESIDENT
JOHN BARTON PAYNE. CHAIRMAN
ROBERT W. DE FOREST. VICE PRESIDENT
MRS. AUGUST BELMONT
CALVIN COOLIDGE, VICE PRESIDENT
THE AMERICAN RED CROSS
CORNELIUS N. BLISS
MABEL T. BOARDMAN
THOMAS D. THACHER, COUNSELOR
JOSEPH P. COTTON
OGDEN L. MILLS. TREASURER
NATIONAL HEADQUARTERS
MRS. HENRY P. DAVISON
MABEL T. BOARDMAN, SECRETARY
E. B. DOUGLAS
WASHINGTON. D. C.
MRS. FRANK V. HAMMAR
MAJ. GEN. M. W. IRELAND
NATIONAL EXECUTIVE OFFICERS
SAMUEL KNIGHT
OGDEN L. MILLS
JOHN BARTON PAYNE. CHAIRMAN
GUSTAVUS D. POPE
JAMES L. FIESER. VICE CHAIRMAN
MRS. HENRY R. REA
REAR ADMIRAL CHARLES E. RIGGS
ERNEST P. BICKNELL, VICE CHAIRMAN
JOHN D. RYAN
JAMES K. MCCLINTOCK. VICE CHAIRMAN
GEORGE E. SCOTT
THOMAS D. THACHER
ELIOT WADSWORTH
Dear Madam:
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 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 enclosed envelope, at the earliest possible date.
IMPORTANT:
Yours sincerely,
In order to render prompt service
Chairman or
in time of disaster, enrolled Red Cross
ELLA E. MONEIT,, R.: N.
Secretary.
nurses should report at once to the
2100 DELANCEY STREET
Secretary of the Local Committee under
PHILADELPHIA; PENNA. Local Committee.
which they are enrolled. Do not forget
the address of the Secretary.
Name in full
If married, give husband's name
Permanent address HAOO Baltimore are (CITY) Philadelphia OUNTY) Pa- (STATE)
(STREET, ETC.)
Probable address for the next year
same
(STREET, ETC.)
Telephone No.
Bar 256le
(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)
None
Underline the type of work
you are now doing: - Army - Navy - U.S.P.H. Hospital - U.S.Vet. Hospital - Public
Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar.
Are you an of Red Cross classes in Home Hygiene and Care
instructor of the Sick? no
Have you ever been?
no
Indicate present physical condition
good
Would you respond to an emergency call in event of epidemic, disaster, war, etc.?
Badge No. 23904
Current date February 28-1931
NOTE.--I the nurse does not complete and return this questionnaire, and can not be
located within two years, her enrolment will be annulled.
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"ocrText": "+\nFORM 1045 REV. 1-7-30\nNATIONAL OFFICERS\nCENTRAL COMMITTEE\nHERBERT HOOVER. PRESIDENT\nJOHN BARTON PAYNE. CHAIRMAN\nROBERT W. DE FOREST. VICE PRESIDENT\nMRS. AUGUST BELMONT\nCALVIN COOLIDGE, VICE PRESIDENT\nTHE AMERICAN RED CROSS\nCORNELIUS N. BLISS\nMABEL T. BOARDMAN\nTHOMAS D. THACHER, COUNSELOR\nJOSEPH P. COTTON\nOGDEN L. MILLS. TREASURER\nNATIONAL HEADQUARTERS\nMRS. HENRY P. DAVISON\nMABEL T. BOARDMAN, SECRETARY\nE. B. DOUGLAS\nWASHINGTON. D. C.\nMRS. FRANK V. HAMMAR\nMAJ. GEN. M. W. IRELAND\nNATIONAL EXECUTIVE OFFICERS\nSAMUEL KNIGHT\nOGDEN L. MILLS\nJOHN BARTON PAYNE. CHAIRMAN\nGUSTAVUS D. POPE\nJAMES L. FIESER. VICE CHAIRMAN\nMRS. HENRY R. REA\nREAR ADMIRAL CHARLES E. RIGGS\nERNEST P. BICKNELL, VICE CHAIRMAN\nJOHN D. RYAN\nJAMES K. MCCLINTOCK. VICE CHAIRMAN\nGEORGE E. SCOTT\nTHOMAS D. THACHER\nELIOT WADSWORTH\nDear Madam:\nThe National Committee on Red Cross Nursing Service requires us to submit,\nannually, a list of all the Red Cross Nurses enrolled with our Committee, with their\nlatest addresses. We are extremely anxious to make a very complete report to National\nHeadquarters and ask for your cooperation. Please answer the following questions and\nreturn this form to me, in enclosed envelope, at the earliest possible date.\nIMPORTANT:\nYours sincerely,\nIn order to render prompt service\nChairman or\nin time of disaster, enrolled Red Cross\nELLA E. MONEIT,, R.: N.\nSecretary.\nnurses should report at once to the\n2100 DELANCEY STREET\nSecretary of the Local Committee under\nPHILADELPHIA; PENNA. Local Committee.\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nName in full\nIf married, give husband's name\nPermanent address HAOO Baltimore are (CITY) Philadelphia OUNTY) Pa- (STATE)\n(STREET, ETC.)\nProbable address for the next year\nsame\n(STREET, ETC.)\nTelephone No.\nBar 256le\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)\nNone\nUnderline the type of work\nyou are now doing: - Army - Navy - U.S.P.H. Hospital - U.S.Vet. Hospital - Public\nHealth - Institutional - Private Duty - Industrial - Office Nurse - Registrar.\nAre you an of Red Cross classes in Home Hygiene and Care\ninstructor of the Sick? no\nHave you ever been?\nno\nIndicate present physical condition\ngood\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.?\nBadge No. 23904\nCurrent date February 28-1931\nNOTE.--I the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrolment will be annulled."
}