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FORM 1045 REV. 1-2-35 THE AMERICAN RED CROSS M NATIONAL HEADQUARTERS WASHINGTON, D. c. H Dear Madam: 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 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 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 in time of disaster, enrolled Red Cross HELEN STEPHEN Chairman or STREET Secretary. Nurses should report at once to the Secretary of the Local Committee under ORANGE, - N.J. Local Committee. which they are enrolled. Do not forget the address of the Secretary. Name in full Marie I Camebbell If married, give husband's name Permanent address P.O.Box18 Illiddlebury NEW Hancu Coure (STREET, ETC.) (CITY) (COUNTY) (STATE) Probable address for the next year Drange Memorial Nospital (STREET, ETC.) Telephone No. Dr. 10,00 Drange Essex New Jersey (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) Digues a Riualdi (sister) 0.0 Bax 18 Widdlebury Pours Underline the type of work you are now doing: Army - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service - W Public Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar. 5, 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 Good 8 Would you respond to an emergency call in event of epidemic, disaster, war, etc. ? yes 6 Badge No. 35586 Current date March 26 be 1937 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. 1-2-35\nTHE AMERICAN RED CROSS\nM\nNATIONAL HEADQUARTERS\nWASHINGTON, D. c.\nH\nDear Madam:\nThe National Committee on Red Cross Nursing Service requires us to submit,\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\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\nin time of disaster, enrolled Red Cross\nHELEN STEPHEN\nChairman or\nSTREET\nSecretary.\nNurses should report at once to the\nSecretary of the Local Committee under\nORANGE,\n-\nN.J.\nLocal Committee.\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nName in full\nMarie I Camebbell\nIf married, give husband's name\nPermanent\naddress P.O.Box18\nIlliddlebury NEW Hancu\nCoure\n(STREET, ETC.)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address for the next year\nDrange Memorial Nospital\n(STREET, ETC.)\nTelephone No. Dr. 10,00\nDrange Essex New Jersey\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)\nDigues a Riualdi (sister) 0.0 Bax 18 Widdlebury Pours\nUnderline the type of work you are now doing:\nArmy - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service -\nW\nPublic Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar.\n5,\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? No\nHave you ever been? No\nIndicate present physical condition Good\n8\nWould you respond to an emergency call in event of epidemic, disaster, war, etc. ? yes\n6\nBadge No. 35586\nCurrent date March 26 be 1937\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."
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