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FORM 1045
REV. 12-3-37
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. C.
e
Dear Red Cross Nurse:
7
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
T
therefore, please answer the following questions and return this form to me, in the
c
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:
Yours sincerely,
In order to render prompt service
Chairman or
in time of disaster, enrolled Red Cross
MARIE RYAN
Secretary.
Nurses should report at once to the
Secretary of the Local Committee under
2246 N. 4th St.
Columbus, Ohio
Local Committee.
which they are enrolled. Do not forget
the address of the Secretary.
sarah Gertrude Bush
Name in full
If married, give husband's name
Permanent address
132 E. Come Columebus
Frouklin
ohio
(STREET, ETC.)
(CITY)
(COUNTY)
(STATE)
Probable address for the next year
(STREET, ETC.)
Telephone No. La6918
(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)
Ella P. Bush mother same address
Underline the type of work you are now doing:
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 Hygiene
in Home and Care of the Sick? to
Have you ever been?
yes
Indicate present physical condition good
2
0
Would you respond to an emergency call in event of epidemic, disaster, war, etc. yet
Badge No. 20614
Current date may 1938
6
-
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.
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"ocrText": "FORM 1045\nREV. 12-3-37\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\ne\nDear Red Cross Nurse:\n7\nThe National Committee on Red Cross Nursing Service requires us to submit,\n+\nannually, a report of all the Red Cross Nurses enrolled with our Committee. Will you\nT\ntherefore, please answer the following questions and return this form to me, in the\nc\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:\nYours sincerely,\nIn order to render prompt service\nChairman or\nin time of disaster, enrolled Red Cross\nMARIE RYAN\nSecretary.\nNurses should report at once to the\nSecretary of the Local Committee under\n2246 N. 4th St.\nColumbus, Ohio\nLocal Committee.\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nsarah Gertrude Bush\nName in full\nIf married, give husband's name\nPermanent address\n132 E. Come Columebus\nFrouklin\nohio\n(STREET, ETC.)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address for the next year\n(STREET, ETC.)\nTelephone No. La6918\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)\nElla P. Bush mother same address\nUnderline the type of work you are now doing:\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 Hygiene\nin Home and Care of the Sick? to\nHave you ever been?\nyes\nIndicate present physical condition good\n2\n0\nWould you respond to an emergency call in event of epidemic, disaster, war, etc. yet\nBadge No. 20614\nCurrent date may 1938\n6\n-\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."
}