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FORM 1045
AMERICAN RED CROSS
REV. DEC. 1939
NATIONAL HEADQUARTERS
WASHINGTON, D. C.
Butter
Name in full
Ida
7
(SURNAME)
(FIRST)
(MIDDLE)
Husband's name
Permanent address 7 So Highland St Mast Harifing Crush
(STREET)
(CITY)
(COUNTY)
(STATE)
Probable address
The same
for the next year
(STREET)
(CITY)
(COUNTY)
(STATE)
Telephone number
(EXCHANGE)
(NO.)
Nearest relative or friend in United States, through whom you may be communicated with in
an emergency:
In Janua (NAME) G. Butter
nephew
(RELATIONSHIP)
204 month Duaker Lune you Harifies Cm
(STREET)
(CITY)
(STATE)
PRESENT WORK (check below)
Name of agency or institution with which employed
Institutional
Public Health
Sam nterial. -
Private duty
Other (write in)
Government Service: Army
U.S.P.H.Service
Veterans Administration
Navy
U.S.Indian Service
Children's Bureau
IF NOT ACTIVE IN NURSING check field of nursing with which you are most familiar:
Institutional
Public Health
Private duty
Other (write in)
Would you respond to an emergency call in event of local or national emergency, such as
epidemic, flood, war, etc.
yes
(Granted of course that you could be released from present employment)
Present physical condition
4nd
Would of Sick? no
you be interested in teaching classes in Home Hygiene and Care the
Are you a member of the American Nurses' Association?
Yes
If not, why have you allowed your membership to lapse?
hour
Badge No. 248
Current date aput S 1948
Name of Committee
Local Pom. Saminer Haitford
Note: If a nurse does not complete and return this questionnaire, and cannot be located
within two years, her enrollment will be removed from our active files.
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- Source index
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- Type
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- 9474853958e8ab0d
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Document data
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- Core
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- Type
- document
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Context sent to Scholar
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"ocrText": "FORM 1045\nAMERICAN RED CROSS\nREV. DEC. 1939\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\nButter\nName in full\nIda\n7\n(SURNAME)\n(FIRST)\n(MIDDLE)\nHusband's name\nPermanent address 7 So Highland St Mast Harifing Crush\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address\nThe same\nfor the next year\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nTelephone number\n(EXCHANGE)\n(NO.)\nNearest relative or friend in United States, through whom you may be communicated with in\nan emergency:\nIn Janua (NAME) G. Butter\nnephew\n(RELATIONSHIP)\n204 month Duaker Lune you Harifies Cm\n(STREET)\n(CITY)\n(STATE)\nPRESENT WORK (check below)\nName of agency or institution with which employed\nInstitutional\nPublic Health\nSam nterial. -\nPrivate duty\nOther (write in)\nGovernment Service: Army\nU.S.P.H.Service\nVeterans Administration\nNavy\nU.S.Indian Service\nChildren's Bureau\nIF NOT ACTIVE IN NURSING check field of nursing with which you are most familiar:\nInstitutional\nPublic Health\nPrivate duty\nOther (write in)\nWould you respond to an emergency call in event of local or national emergency, such as\nepidemic, flood, war, etc.\nyes\n(Granted of course that you could be released from present employment)\nPresent physical condition\n4nd\nWould of Sick? no\nyou be interested in teaching classes in Home Hygiene and Care the\nAre you a member of the American Nurses' Association?\nYes\nIf not, why have you allowed your membership to lapse?\nhour\nBadge No. 248\nCurrent date aput S 1948\nName of Committee\nLocal Pom. Saminer Haitford\nNote: If a nurse does not complete and return this questionnaire, and cannot be located\nwithin two years, her enrollment will be removed from our active files."
}