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FORM 1045 REV. 2-16-31
NATIONAL OFFICERS
CENTRAL COMMITTEE
L
P
HERBERT HOOVER, PRESIDENT
JOHN BARTON PAYNE, CHAIRMAN
MRS. AUGUST BELMONT
ROBERT w. DE FOREST, VICE PRESIDENT
CORNELIUS N. BLISS
a
0
CALVIN COOLIDGE, VICE PRESIDENT
THE AMERICAN RED CROSS
MABEL T. BOARDMAN
JOSEPH P COTTON
<
CHARLES EVANS HUGHES, VICE PRESIDENT
NATIONAL HEADQUARTERS
MRS. HENRY P. DAVISON
THOMAS D. THACHER, COUNSELOR
MRS. FRANK v. HAMMAR
OGDEN L. MILLS, TREASURER
WASHINGTON, D.C.
MAJ. GEN. M. w. IRELAND
MABEL T. BOARDMAN, SECRETARY
SAMUEL KNIGHT
OGDEN L. MILLS
GUSTAVUS D. POPE
NATIONAL EXECUTIVE OFFICERS
MRS. HENRY R. REA
REAR ADMIRAL CHARLES E. RIGGS
JOHN BARTON PAYNE, CHAIRMAN
JOHN D. RYAN
JAMES L. FIESER, VICE CHAIRMAN
GEORGE E. SCOTT
HENRY UPSON SIMS
ERNEST P. BICKNELL, VICE CHAIRMAN
THOMAS D. THACHER
JAMES K. MCCLINTOCK, VICE CHAIRMAN
ELIOT WADSWORTH
TS
L
a
Dear Madam:
FEB 22 1932
<
The National Committee on Red Cross Nursing Service requires us to submit,
annually, a list of all the Red Cross Nurses enrolled with our Committee, with their
en
latest addresses. We are extremely anxious to make a very complete report to National
Headquarters and ask for your cooperation. Please answer the following questions and
return this form to me, in enclosed envelope, at the earliest possible date.
IMPORTANT:
In order to render prompt service
Yours sincerely,
in time of disaster, enrolled Red Cross
HELEN E. SHEARSTON,
Chairman or
Nurses should report at once to the
Secretary.
Secretary of the Local Committee under
MARYLAND STATE AND LOCAL COMMITTEE
which they are enrolled. Do not forget
RED cross NURSING
SERVICE Local
Committee.
the address of the Segretary.
OF MARYLAND,
PALTIMORE, MARYLAND.
Name in full Lavenier rene Hovenfort
If
married, give husband's name Royal W. Teevenfort
Permanent address 114 STREET, ETC. CITY Chevychange montgomery COUNTY Maryland STATE
Probable address Some
for the next year
STREET, ETC.
Telephone No. Wisconsin 3287f
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)
Royal W. Teemenport I lusbad
Underline the type of work
you are now doing: Army - Navy - U.S.P.H. Hospital - U.S. Vet. Hospital - 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? yes
Indicate present physical condition Excellent.
coved not
Would you respond to an emergency call in event of epidemic, disaster, war, etc.?
leove
Badge No. 37892
Current date april 12 1982
Family
NOTE.--If the nurse does not complete and return this questionnaire, and can not be
located within two years, her enrolment will be annulled.
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"ocrText": "N\nD\n&\n/\nL\ne\n5\nFORM 1045 REV. 2-16-31\nNATIONAL OFFICERS\nCENTRAL COMMITTEE\nL\nP\nHERBERT HOOVER, PRESIDENT\nJOHN BARTON PAYNE, CHAIRMAN\nMRS. AUGUST BELMONT\nROBERT w. DE FOREST, VICE PRESIDENT\nCORNELIUS N. BLISS\na\n0\nCALVIN COOLIDGE, VICE PRESIDENT\nTHE AMERICAN RED CROSS\nMABEL T. BOARDMAN\nJOSEPH P COTTON\n<\nCHARLES EVANS HUGHES, VICE PRESIDENT\nNATIONAL HEADQUARTERS\nMRS. HENRY P. DAVISON\nTHOMAS D. THACHER, COUNSELOR\nMRS. FRANK v. HAMMAR\nOGDEN L. MILLS, TREASURER\nWASHINGTON, D.C.\nMAJ. GEN. M. w. IRELAND\nMABEL T. BOARDMAN, SECRETARY\nSAMUEL KNIGHT\nOGDEN L. MILLS\nGUSTAVUS D. POPE\nNATIONAL EXECUTIVE OFFICERS\nMRS. HENRY R. REA\nREAR ADMIRAL CHARLES E. RIGGS\nJOHN BARTON PAYNE, CHAIRMAN\nJOHN D. RYAN\nJAMES L. FIESER, VICE CHAIRMAN\nGEORGE E. SCOTT\nHENRY UPSON SIMS\nERNEST P. BICKNELL, VICE CHAIRMAN\nTHOMAS D. THACHER\nJAMES K. MCCLINTOCK, VICE CHAIRMAN\nELIOT WADSWORTH\nTS\nL\na\nDear Madam:\nFEB 22 1932\n<\nThe National Committee on Red Cross Nursing Service requires us to submit,\nannually, a list of all the Red Cross Nurses enrolled with our Committee, with their\nen\nlatest addresses. We are extremely anxious to make a very complete report to National\nHeadquarters and ask for your cooperation. Please answer the following questions and\nreturn this form to me, in enclosed envelope, at the earliest possible date.\nIMPORTANT:\nIn order to render prompt service\nYours sincerely,\nin time of disaster, enrolled Red Cross\nHELEN E. SHEARSTON,\nChairman or\nNurses should report at once to the\nSecretary.\nSecretary of the Local Committee under\nMARYLAND STATE AND LOCAL COMMITTEE\nwhich they are enrolled. Do not forget\nRED cross NURSING\nSERVICE Local\nCommittee.\nthe address of the Segretary.\nOF MARYLAND,\nPALTIMORE, MARYLAND.\nName in full Lavenier rene Hovenfort\nIf\nmarried, give husband's name Royal W. Teevenfort\nPermanent address 114 STREET, ETC. CITY Chevychange montgomery COUNTY Maryland STATE\nProbable address Some\nfor the next year\nSTREET, ETC.\nTelephone No. Wisconsin 3287f\nCITY\nCOUNTY\nSTATE\nName and address of nearest relative or friend, in United States, through whom you may\nbe communicated with in an emergency. (State relationship)\nRoyal W. Teemenport I lusbad\nUnderline the type of work\nyou are now doing: Army - Navy - U.S.P.H. Hospital - U.S. Vet. Hospital - U.S. Indian\nService - Public Health - Institutional - Private Duty - Industrial - Office Nurse -\nRegistrar.\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick?\nno.\nHave you ever been? yes\nIndicate present physical condition Excellent.\ncoved not\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.?\nleove\nBadge No. 37892\nCurrent date april 12 1982\nFamily\nNOTE.--If the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrolment will be annulled."
}