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FORM 1045
REV. 12-3-37
M
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
2
a
WASHINGTON, D. c.
6
V
e
12
QUESTIONNAIRES DESTROYED
Dear Red Cross Nurse:
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:
In order to render prompt service
Yours sincerely,
FLORENCE M 10 NSON
Chairman or
in time of disaster, enrolled Red Cross
Nurses should report at once to the
Secretary.
Secretary of the Local Committee under
MANHATTAN
Local Committee.
which they are enrolled. Do not forget
the address of the Secretary.
Name in full
Mabel Davies, B. N
If married, give husband's name
--
Permanent address
117 Beekman Street, New York, N.Y.
(STREET, ETC.)
(CITY)
(COUNTY)
(STATE)
Probable address for the next year
117 Beekman Street, New York City
(STREET, ETC.)
Telephone No. Beekman 3-5300
New York City
N.Y.
(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)
Mrs. G. T. Wilson (Friend), 128 East 34th Street, New York City
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 in Home Hygiene and Care of the Sick?
No
Have you ever been?
No.
Indicate present physical condition
Good
Yes
Would you respond to an emergency call in event of epidemic, disaster, war, etc.?
20324
Badge No.
Current date
March 12,1938
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": "I\naN\nes\nFORM 1045\nREV. 12-3-37\nM\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\n2\na\nWASHINGTON, D. c.\n6\nV\ne\n12\nQUESTIONNAIRES DESTROYED\nDear Red Cross Nurse:\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:\nIn order to render prompt service\nYours sincerely,\nFLORENCE M 10 NSON\nChairman or\nin time of disaster, enrolled Red Cross\nNurses should report at once to the\nSecretary.\nSecretary of the Local Committee under\nMANHATTAN\nLocal Committee.\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nName in full\nMabel Davies, B. N\nIf married, give husband's name\n--\nPermanent address\n117 Beekman Street, New York, N.Y.\n(STREET, ETC.)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address for the next year\n117 Beekman Street, New York City\n(STREET, ETC.)\nTelephone No. Beekman 3-5300\nNew York City\nN.Y.\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)\nMrs. G. T. Wilson (Friend), 128 East 34th Street, New York City\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 in Home Hygiene and Care of the Sick?\nNo\nHave you ever been?\nNo.\nIndicate present physical condition\nGood\nYes\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.?\n20324\nBadge No.\nCurrent date\nMarch 12,1938\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."
}