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RED CROSS BADGE NUMBER
AMERICAN RED CROSS
23751
NURSING SERVICES
MILITARY SERIAL NUMBER
M
bet
ANNUAL QUESTIONNAIRE - 1945
CHECK IF YOUR LAST NAME HAS CHANGED
TELEPHOND NO.
NAME (Last, first, middle)
26
Bottenberg, Edith Young
HUSBAND'S NAME
IF MARRIED, GIVE MAIDEN NAME
Edith Young
Thomas E. Bottenberg
3
PERMANENT ADDRESS (Street, city, zone, county, state)
505 N. Liberty - Rushville, Illinois.
TS,
PRESENT ADDRESS (Street, city, zone, county, state)
Thomas E. Bottenberg
RELATIONSHIP
NAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES
E
Husband
DATE OF BIRTH (Month, day, year)
Single
Married
Separated
widowed
Divorced
May 25,1889
YES
NO
WHAT LANGUAGES DO YOU SPEAK?
HIGH SCHOOL GRADUATE
+
DEGREE OR
5
NAME OF COLLEGE OR
UNIVERSITY ATTENDED Dixon Normal LOCATION Dixon, III.
INCLUSIVE DATES
DIPLOMA
MAJOR
3
-
ARE YOU CURRENTLY A MEMBER OF THE AMERICAN
YES
NO.:
ARE YOU CURRENTLY
YES
NO
REGISTERED IN (State)
No
NURSES' ASSOCIATION?
REGISTERED?
PRESENT EMPLOYMENT If not employed, check
x
POSITION TITLE (H.N., P.D., inst., staff nurse, etc.)
SERVICE (Medicine, surgery, etc.)
CITY
STATE
NAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED
HEALTH
IF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY
Gobd
VOLUNTEER SERVICE
The purpose of the following statements is to identify the nurses who can be counted upon to respond and to able a call to
to participate in a Red Cross chapter program. Please check the "Yes" box only if you are villing
NAME ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS
serve if called on within the next 12 months.
Schugler AND County Rusville, Ill
NO ttend an instructors' training program, 1f offered. (Funds are available for
YES
NO
1. Teach home
YES
nursing classes
training home nursing instructors. See local chapter.)
Attend disaster institutes, if
YES
NO
2. Serve in case
YES
NO
only in home community
In other communities
offered, in preparation for service
of disaster
3. Teach nurse's
4. Accept membership on chapter com-
YES
NO
5. Assist with other chapter
YES
NO
YES
NO
programs, as needed
aide classes
mittee should services be 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-
Husband has heart trouble.
IGNATURE
DATE
Sept. 16, 1945
VALUE AS 4 RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS to SERVE AND YOUR FAITRFOLNESS THE
with Batterbery
IN
KEEPING YOUR US INFORMAD OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN If PROMPTLY TO
2
COMMITTEE NAMED BELOW.
ling questionnaire to nurse.
a
3
ATTENTION
Miss Maud Estelle Guest,
SECRETARY
Secretary, Recruitment Committee,
NURSE RECRUITMENT
199145
J
Adams County Chapter,
COMMITTEE
American Red Cross, St. Mary's Hospital
FORM 1045 Rev. July 1945
5
78504M
Quincy. Illinois.
Page data
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- Source index
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Document data
- ID
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- Core
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- Type
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DTO data
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"ocrText": "Z\nRED CROSS BADGE NUMBER\nAMERICAN RED CROSS\n23751\nNURSING SERVICES\nMILITARY SERIAL NUMBER\nM\nbet\nANNUAL QUESTIONNAIRE - 1945\nCHECK IF YOUR LAST NAME HAS CHANGED\nTELEPHOND NO.\nNAME (Last, first, middle)\n26\nBottenberg, Edith Young\nHUSBAND'S NAME\nIF MARRIED, GIVE MAIDEN NAME\nEdith Young\nThomas E. Bottenberg\n3\nPERMANENT ADDRESS (Street, city, zone, county, state)\n505 N. Liberty - Rushville, Illinois.\nTS,\nPRESENT ADDRESS (Street, city, zone, county, state)\nThomas E. Bottenberg\nRELATIONSHIP\nNAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES\nE\nHusband\nDATE OF BIRTH (Month, day, year)\nSingle\nMarried\nSeparated\nwidowed\nDivorced\nMay 25,1889\nYES\nNO\nWHAT LANGUAGES DO YOU SPEAK?\nHIGH SCHOOL GRADUATE\n+\nDEGREE OR\n5\nNAME OF COLLEGE OR\nUNIVERSITY ATTENDED Dixon Normal LOCATION Dixon, III.\nINCLUSIVE DATES\nDIPLOMA\nMAJOR\n3\n-\nARE YOU CURRENTLY A MEMBER OF THE AMERICAN\nYES\nNO.:\nARE YOU CURRENTLY\nYES\nNO\nREGISTERED IN (State)\nNo\nNURSES' ASSOCIATION?\nREGISTERED?\nPRESENT EMPLOYMENT If not employed, check\nx\nPOSITION TITLE (H.N., P.D., inst., staff nurse, etc.)\nSERVICE (Medicine, surgery, etc.)\nCITY\nSTATE\nNAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED\nHEALTH\nIF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY\nGobd\nVOLUNTEER SERVICE\nThe purpose of the following statements is to identify the nurses who can be counted upon to respond and to able a call to\nto participate in a Red Cross chapter program. Please check the \"Yes\" box only if you are villing\nNAME ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS\nserve if called on within the next 12 months.\nSchugler AND County Rusville, Ill\nNO ttend an instructors' training program, 1f offered. (Funds are available for\nYES\nNO\n1. Teach home\nYES\nnursing classes\ntraining home nursing instructors. See local chapter.)\nAttend disaster institutes, if\nYES\nNO\n2. Serve in case\nYES\nNO\nonly in home community\nIn other communities\noffered, in preparation for service\nof disaster\n3. Teach nurse's\n4. Accept membership on chapter com-\nYES\nNO\n5. Assist with other chapter\nYES\nNO\nYES\nNO\nprograms, as needed\naide classes\nmittee should services be 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-\nHusband has heart trouble.\nIGNATURE\nDATE\nSept. 16, 1945\nVALUE AS 4 RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS to SERVE AND YOUR FAITRFOLNESS THE\nwith Batterbery\nIN\nKEEPING YOUR US INFORMAD OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN If PROMPTLY TO\n2\nCOMMITTEE NAMED BELOW.\nling questionnaire to nurse.\na\n3\nATTENTION\nMiss Maud Estelle Guest,\nSECRETARY\nSecretary, Recruitment Committee,\nNURSE RECRUITMENT\n199145\nJ\nAdams County Chapter,\nCOMMITTEE\nAmerican Red Cross, St. Mary's Hospital\nFORM 1045 Rev. July 1945\n5\n78504M\nQuincy. Illinois."
}