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FORM 1045
REV. 4-4-38
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. c.
12 QUESTIONNAIRES DESTROYES
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:
Yours sincerely,
In order to render prompt service
Chairman or
in time of disaster, enrolled Red Cross
Nurses should report at once to the
Secretary.
Secretary of the Local Committee under
Local Committee.
which they are enrolled. Do not forget
the address of the Secretary.
Name in full
Mariory Storey
If married, give husband's name
Permanent address 30. Hortense Street
Rochester
Monroe
New York
(STREET. ETC.)
(CITY)
(COUNTY)
(STATE)
Probable address for the next year
Same
(STREET, ETC.)
Telephone No.
Genesee 4774
(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)
Mrs. J.M. Spinning, 568 Wellington Ave., Rochester, N.Y. (Sister)
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
Have you ever been?
No
Would you like to teach Red Cross classes?
Indicate present physical condition
Good
Would you respond to an emergency call in event of epidemic, disaster,
etc.?
Yes
Badge No. 41828
Current date February 22, 1939
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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"ocrText": "FORM 1045\nREV. 4-4-38\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. c.\n12 QUESTIONNAIRES DESTROYES\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:\nYours sincerely,\nIn order to render prompt service\nChairman or\nin time of disaster, enrolled Red Cross\nNurses should report at once to the\nSecretary.\nSecretary of the Local Committee under\nLocal Committee.\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nName in full\nMariory Storey\nIf married, give husband's name\nPermanent address 30. Hortense Street\nRochester\nMonroe\nNew York\n(STREET. ETC.)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address for the next year\nSame\n(STREET, ETC.)\nTelephone No.\nGenesee 4774\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)\nMrs. J.M. Spinning, 568 Wellington Ave., Rochester, N.Y. (Sister)\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.\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? No\nHave you ever been?\nNo\nWould you like to teach Red Cross classes?\nIndicate present physical condition\nGood\nWould you respond to an emergency call in event of epidemic, disaster,\netc.?\nYes\nBadge No. 41828\nCurrent date February 22, 1939\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."
}