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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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"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"
}