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FORM 1045
REV. 4-4-38
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON. D. c.
15
QUESTIONNAIRES DESTROYED
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:
In order to render prompt service
Yours sincerely,
in time of disaster, enrolled Red Cross
F. ELNA SMITTEN,
Chairman or
Nurses should report at once to the
Secretary Local Committee
Secretary.
Secretary of the Local Committee under
RED CROSS NURSING SERVICE
which they are enrolled. Do not forget
519 Smithfield St.
Local Committee.
the address of the Secretary.
PITTSBURGH, PA.
Name in full
If married, give husband's name no
Jesse I Jumbull
Permanent address 316 1 talker or maser (CITY) Hoyal (COUNTY) Pgh (STATE) Pa
(STREET. ETC.)
Probable address for the next year
massov same
(STREET, ETC.)
Telephone No. master
Pglr
Haekel se
(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)
Sister ma Hemmetta more 8.7 Flogun Plag
Underline the type of work you are now doing:
and Letana
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 classes in Home Care of the Sick?
Suit Cross of Hospital Hygiene and
no
Have you been?
ever year
Would you like to teach Red Cross classes? and
Indicate present physical condition Excellent
Would you respond to an emergency call in event of epidemic, disaster, war, etc.?
yes
Badge No. 7,032
Current
date 1-17-90
NOTE.- 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. 4-4-38\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON. D. c.\n15\nQUESTIONNAIRES DESTROYED\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:\nIn order to render prompt service\nYours sincerely,\nin time of disaster, enrolled Red Cross\nF. ELNA SMITTEN,\nChairman or\nNurses should report at once to the\nSecretary Local Committee\nSecretary.\nSecretary of the Local Committee under\nRED CROSS NURSING SERVICE\nwhich they are enrolled. Do not forget\n519 Smithfield St.\nLocal Committee.\nthe address of the Secretary.\nPITTSBURGH, PA.\nName in full\nIf married, give husband's name no\nJesse I Jumbull\nPermanent address 316 1 talker or maser (CITY) Hoyal (COUNTY) Pgh (STATE) Pa\n(STREET. ETC.)\nProbable address for the next year\nmassov same\n(STREET, ETC.)\nTelephone No. master\nPglr\nHaekel se\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)\nSister ma Hemmetta more 8.7 Flogun Plag\nUnderline the type of work you are now doing:\nand Letana\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 classes in Home Care of the Sick?\nSuit Cross of Hospital Hygiene and\nno\nHave you been?\never year\nWould you like to teach Red Cross classes? and\nIndicate present physical condition Excellent\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.?\nyes\nBadge No. 7,032\nCurrent\ndate 1-17-90\nNOTE.- 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."
}