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Conrad, Mrs. Dorothy Watkins, Badge #H.D. 8270
ek
RED CROSS BADGE NUMBER
AMERICAN RED CROSS
2
HD8270
NURSING SERVICES
MILITARY SERIAL NUMBER
ANNUAL QUESTIONNAIRE - 1945
CHECK IF YOUR LAST NAME HAS CHANGED
NAME (Last, first, middle)
Conrad, Forathy Waltinis
TELEPHONE NO.
les 0420
IF MARRIED, GIVE MAIDEN-NAME
HUSBAND'S NAME
Walteris Faracter
Caurad, W L.
PERMANENT
ADDRESS (Street, city, zone, county, state)
1340 ash Street, Jenner Colorado
PRESENT ADDRESS (Street, city, zone, county, state)
3701 massachusitt are h. w. jasheydan D.C.
C
NAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES
WELATIONSHIP
wm L. Cawar, 1340 ash u, Jenues Culo
Husband
DATE OF BIRTH (Month, day, year)
7-31-1898
Single
Ma Ted
Separated
W1 dowed
Divorced
WHAT LANGUAGES DO YOU SPEAK?
YES
NO
HIGH SCHOOL GRADUATE
NAME OF COLLEGE OR
DEGREE OR
UNIVERSITY ATTENDED
LOCATION
INCLUSIVE DATES
DIPLOMA
MAJOR
Teachers College
h.y, City
B.S
Columbur u.
Education
4
N
Jennes u.
Jennes Collo
M,A. Research
a
+
ARE YOU CURRENTLY
YES
NO
REGISTERED IN (State)
ARE YOU CURRENTLY A MEMBER OF THE AMERICAN
YES
NO
K
REGISTERED?
n.y Culo
NURSES' ASSOCIATION?
PRESENT EMPLOYMENT If not employed, check
POSITION TITLE (H.N., P.D., inst., staff nurse, etc.)
SERVICE (Medicine, surgery, /etc.)
Jeputer admunital arc. .S.
NAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED
CITY
STATE
am kid Cross
ou
HEALTH
IF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY
X
good
VOLUNTEER SERVICE
Ni
The purpose of the following statements is to identify the nurses who cart be counted upon to respond to a call
to participate in a Red Cross chapter program. Please check the "Yes" box only if you are 201 and able to
serve if called on within the next 12 months.
ii
NAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS
Districl chapter 20 arlunyton D.C.
1. Teach home
YES
NO
Attend an instructors' training program, Or of fered. (Funds are available for
YES
NO
nursing classes
training home nursing instructors. See local chapter.)
2. Serve in case
YES
NO
only in home community
Attend disaster institutes, if
YES
NO
of d!saster
In other communities
offered, in preparation for service
I
3. Teach nurse's
YES
NO
4. Accept membership on chapter cóm-
YES
NO
5. Assist with other chapter
YES
NO
aide classes
mittee should services be needed
programs, as needed
If you have not answered "Yes" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that
YES
NO
you will be able to serve at some time in the future?
IF UNABLE TO SERVE, GIVE MAJOR REASONS.
yes
DATE
Employed full dive by are al present.
8
8/8/45
SIGNATURE
Fairally w. Courad
N
YOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR PAITHPOLNESS IN
KEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONWAIRE AND RETURN IT PROMPTLY TO THE
J
COMMITTEE NAMED BELOW.
ATTENTION
Fill in committee name and address before sending questionnaire to nurse.
O
SECRETARY
NURSE RECRUITMENT
COMMITTEE
NATIONAL HEADQUARTERS
78504M
FORM 1045 Rev. July 1945
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Document data
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"ocrText": "Conrad, Mrs. Dorothy Watkins, Badge #H.D. 8270\nek\nRED CROSS BADGE NUMBER\nAMERICAN RED CROSS\n2\nHD8270\nNURSING SERVICES\nMILITARY SERIAL NUMBER\nANNUAL QUESTIONNAIRE - 1945\nCHECK IF YOUR LAST NAME HAS CHANGED\nNAME (Last, first, middle)\nConrad, Forathy Waltinis\nTELEPHONE NO.\nles 0420\nIF MARRIED, GIVE MAIDEN-NAME\nHUSBAND'S NAME\nWalteris Faracter\nCaurad, W L.\nPERMANENT\nADDRESS (Street, city, zone, county, state)\n1340 ash Street, Jenner Colorado\nPRESENT ADDRESS (Street, city, zone, county, state)\n3701 massachusitt are h. w. jasheydan D.C.\nC\nNAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES\nWELATIONSHIP\nwm L. Cawar, 1340 ash u, Jenues Culo\nHusband\nDATE OF BIRTH (Month, day, year)\n7-31-1898\nSingle\nMa Ted\nSeparated\nW1 dowed\nDivorced\nWHAT LANGUAGES DO YOU SPEAK?\nYES\nNO\nHIGH SCHOOL GRADUATE\nNAME OF COLLEGE OR\nDEGREE OR\nUNIVERSITY ATTENDED\nLOCATION\nINCLUSIVE DATES\nDIPLOMA\nMAJOR\nTeachers College\nh.y, City\nB.S\nColumbur u.\nEducation\n4\nN\nJennes u.\nJennes Collo\nM,A. Research\na\n+\nARE YOU CURRENTLY\nYES\nNO\nREGISTERED IN (State)\nARE YOU CURRENTLY A MEMBER OF THE AMERICAN\nYES\nNO\nK\nREGISTERED?\nn.y Culo\nNURSES' ASSOCIATION?\nPRESENT EMPLOYMENT If not employed, check\nPOSITION TITLE (H.N., P.D., inst., staff nurse, etc.)\nSERVICE (Medicine, surgery, /etc.)\nJeputer admunital arc. .S.\nNAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED\nCITY\nSTATE\nam kid Cross\nou\nHEALTH\nIF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY\nX\ngood\nVOLUNTEER SERVICE\nNi\nThe purpose of the following statements is to identify the nurses who cart be counted upon to respond to a call\nto participate in a Red Cross chapter program. Please check the \"Yes\" box only if you are 201 and able to\nserve if called on within the next 12 months.\nii\nNAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS\nDistricl chapter 20 arlunyton D.C.\n1. Teach home\nYES\nNO\nAttend an instructors' training program, Or of fered. (Funds are available for\nYES\nNO\nnursing classes\ntraining home nursing instructors. See local chapter.)\n2. Serve in case\nYES\nNO\nonly in home community\nAttend disaster institutes, if\nYES\nNO\nof d!saster\nIn other communities\noffered, in preparation for service\nI\n3. Teach nurse's\nYES\nNO\n4. Accept membership on chapter cóm-\nYES\nNO\n5. Assist with other chapter\nYES\nNO\naide classes\nmittee should services be needed\nprograms, as needed\nIf you have not answered \"Yes\" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that\nYES\nNO\nyou will be able to serve at some time in the future?\nIF UNABLE TO SERVE, GIVE MAJOR REASONS.\nyes\nDATE\nEmployed full dive by are al present.\n8\n8/8/45\nSIGNATURE\nFairally w. Courad\nN\nYOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR PAITHPOLNESS IN\nKEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONWAIRE AND RETURN IT PROMPTLY TO THE\nJ\nCOMMITTEE NAMED BELOW.\nATTENTION\nFill in committee name and address before sending questionnaire to nurse.\nO\nSECRETARY\nNURSE RECRUITMENT\nCOMMITTEE\nNATIONAL HEADQUARTERS\n78504M\nFORM 1045 Rev. July 1945"
}