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Z FORM 1045 REV. 12-3-37 THE AMERICAN RED CROSS NATIONAL HEADQUARTERS E WASHINGTON, D. c. it 11 11 10-4-45 rs. Dear Red Cross Nurse: x The National Committee on Red Cross Nursing Service requires us to submit, E 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 young a 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, Canie nelson Busine. Secretary. or moon Chairman in time of disaster, enrolled Red Cross Nurses should report at once to the Secretary of the Local Committee under Peorin Ill Local Committee. which they are enrolled. Do not forget the address of the Secretary. Name in full Bettentary If married, give husband's name Themas E. Bettentery Permanent address St. Rustiville, (CITY) Schuyler Illinois. 2397.garkport. (STREET, ETC.) Probable address for the next year 23977 (STREET, ETC.) Rushville, Lee Telephone No. 26 (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) Underline the type of work you are, now doing: Thornas E Bottentery (Housbard) 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 Indicate present physical condition Food Would you respond to an emergency call in event of epidemic, disaster, war, etc.' ? yes Current date Futruary 26, 1938 2 Badge No. 3 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. 50

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Page context
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    "ocrText": "Z\nFORM 1045\nREV. 12-3-37\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nE\nWASHINGTON, D. c.\nit 11 11 10-4-45\nrs.\nDear Red Cross Nurse:\nx\nThe National Committee on Red Cross Nursing Service requires us to submit,\nE\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\nyoung\na\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,\nCanie nelson Busine. Secretary. or\nmoon Chairman\nin time of disaster, enrolled Red Cross\nNurses should report at once to the\nSecretary of the Local Committee under\nPeorin Ill\nLocal Committee.\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nName in full Bettentary\nIf married, give husband's name Themas E. Bettentery\nPermanent address St. Rustiville, (CITY) Schuyler Illinois.\n2397.garkport.\n(STREET, ETC.)\nProbable address for the next year 23977 (STREET, ETC.) Rushville, Lee\nTelephone No. 26\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)\nUnderline the type of work you are, now doing:\nThornas E Bottentery (Housbard)\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\nIndicate present physical condition Food\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.' ? yes\nCurrent date Futruary 26, 1938\n2\nBadge No.\n3\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.\n50"
}