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Biltz, Marian V.
71,413
ek
RED CROSS BADGE NUMBER
AMERICAN RED CROSS
NURSING SERVICES
a
71413
MILITARY SERIAL NUMBER
M
ANNUAL QUESTIONNAIRE - 1945
CHECK IF YOUR LAST NAME HAS CHANGED
a
NAME (Last, first, middle)
TELEPHONE NO.
I
IF
Biltz/ MARRIED, OIVE MAIDEN marian NAME Virginia
HUSBAND'S NAME
an
PERMANENT ADDRESS (Street, city, zone, county, state)
PRESENT ADDRESS (Street, city, zone, county, state)
934 Arite St. Mishawaka St. Joseph Co. Indiana
1709 It. Hashington ave. Ir. houis, Mo.
NAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES
RELATIONSHIP
L
DATE Mr. OF BIRTH George (Month, day, F. Biltz year) 934 E. 4th St. Ohishawaka, And.
Father
3/4/15
Single
Married
Separated
Widowed
Divorced
WHAT LANGUAGES DO YOU SPEAK?
YES
NO
HIGH SCHOOL GRADUATE
NAME OF COLLEGE OR
DEGREE OR
UNIVERSITY ATTENDED
LOCATION
INCLUSIVE DATES
DIPLOMA
MAJOR
BS. in N.Ed.
Indiana University Bloomington, And.
1937-1939
page
Public Heath
nursug
SA
ARE YOU CURRENTLY
YES
NO
REGISTERED IN (State)
ARE YOU CURRENTLY A MEMBER OF THE AMERICAN
YES
NO
Indiania
0
REGISTERED?
NURSES' ASSOCIATION?
Conty
PRESENT EMPLOYMENT If not employed, check
POSITION TITLE (H.N. P.D., inst., staff nurse, etc.)
SERVICE (Medicine, surgery, etc.)
NAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED
nursing Field Representative
CITY
STATE
american Red Cross
HEALTH
IF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY
good
VOLUNTEER SERVICE
The purpose of the following statements is to identify the nurses who can be counted upon to respond to a call
to participate in a Red Cross chapter program. Please check the "Yes" box only for you are willing and able to
serve if called on within the next 12 months.
NAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS
1. Teach home
YES
NO
Attend an instructors' training program, 1f offered (Funds are available fort
YES
NO
nursing classes
training home nursing instructors. See local chapter.) AUG D 10AI
2. Serve in case
YES
NO
only in home community
Attend disaster institutes, if
YES
NO
of d!saster
In other communities
offered, in preparation for service
3. Teach nurse's
YES
NO
4. Accept membership on chapter com-
YES
NO
S. AssistF W1 the other chapter
YES
NO
aide classes
mittee should services be needed
^programs, as needed
If you have not answered "Yes" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that
YES
NO
you will be able to serve at some time in the future?
IF UNABLE TO SERVE, GIVE MAJOR REASONS.
DATE
Aug.14,1945
IGNATURE Marian Bilts,
YOUR VALUE AS X RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR PAITHFOLNESS IN
KEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY TO THE
COMMITTEE NAMED BELOW.
ATTENTION
Fill in committee name and address before sending questionnaire to nurse.
SECRETARY
NURSE RECRUITMENT
NATIONAL HEADQUARTERS
COMMITTEE
78504M
returned by nurse-
8/22/45
FORM 1045 Rev. July 1945
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Document data
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"ocrText": "B\n-\n-\n+\n/\n2\nBiltz, Marian V.\n71,413\nek\nRED CROSS BADGE NUMBER\nAMERICAN RED CROSS\nNURSING SERVICES\na\n71413\nMILITARY SERIAL NUMBER\nM\nANNUAL QUESTIONNAIRE - 1945\nCHECK IF YOUR LAST NAME HAS CHANGED\na\nNAME (Last, first, middle)\nTELEPHONE NO.\nI\nIF\nBiltz/ MARRIED, OIVE MAIDEN marian NAME Virginia\nHUSBAND'S NAME\nan\nPERMANENT ADDRESS (Street, city, zone, county, state)\nPRESENT ADDRESS (Street, city, zone, county, state)\n934 Arite St. Mishawaka St. Joseph Co. Indiana\n1709 It. Hashington ave. Ir. houis, Mo.\nNAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES\nRELATIONSHIP\nL\nDATE Mr. OF BIRTH George (Month, day, F. Biltz year) 934 E. 4th St. Ohishawaka, And.\nFather\n3/4/15\nSingle\nMarried\nSeparated\nWidowed\nDivorced\nWHAT LANGUAGES DO YOU SPEAK?\nYES\nNO\nHIGH SCHOOL GRADUATE\nNAME OF COLLEGE OR\nDEGREE OR\nUNIVERSITY ATTENDED\nLOCATION\nINCLUSIVE DATES\nDIPLOMA\nMAJOR\nBS. in N.Ed.\nIndiana University Bloomington, And.\n1937-1939\npage\nPublic Heath\nnursug\nSA\nARE YOU CURRENTLY\nYES\nNO\nREGISTERED IN (State)\nARE YOU CURRENTLY A MEMBER OF THE AMERICAN\nYES\nNO\nIndiania\n0\nREGISTERED?\nNURSES' ASSOCIATION?\nConty\nPRESENT EMPLOYMENT If not employed, check\nPOSITION TITLE (H.N. P.D., inst., staff nurse, etc.)\nSERVICE (Medicine, surgery, etc.)\nNAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED\nnursing Field Representative\nCITY\nSTATE\namerican Red Cross\nHEALTH\nIF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY\ngood\nVOLUNTEER SERVICE\nThe purpose of the following statements is to identify the nurses who can be counted upon to respond to a call\nto participate in a Red Cross chapter program. Please check the \"Yes\" box only for you are willing and able to\nserve if called on within the next 12 months.\nNAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS\n1. Teach home\nYES\nNO\nAttend an instructors' training program, 1f offered (Funds are available fort\nYES\nNO\nnursing classes\ntraining home nursing instructors. See local chapter.) AUG D 10AI\n2. Serve in case\nYES\nNO\nonly in home community\nAttend disaster institutes, if\nYES\nNO\nof d!saster\nIn other communities\noffered, in preparation for service\n3. Teach nurse's\nYES\nNO\n4. Accept membership on chapter com-\nYES\nNO\nS. AssistF W1 the other chapter\nYES\nNO\naide classes\nmittee should services be needed\n^programs, as needed\nIf you have not answered \"Yes\" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that\nYES\nNO\nyou will be able to serve at some time in the future?\nIF UNABLE TO SERVE, GIVE MAJOR REASONS.\nDATE\nAug.14,1945\nIGNATURE Marian Bilts,\nYOUR VALUE AS X RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR PAITHFOLNESS IN\nKEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY TO THE\nCOMMITTEE NAMED BELOW.\nATTENTION\nFill in committee name and address before sending questionnaire to nurse.\nSECRETARY\nNURSE RECRUITMENT\nNATIONAL HEADQUARTERS\nCOMMITTEE\n78504M\nreturned by nurse-\n8/22/45\nFORM 1045 Rev. July 1945"
}