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FORM 1045 REV. 1-7-30
NATIONAL OFFICERS
CENTRAL COMMITTEE
HERBERT HOOVER, PRESIDENT
JOHN BARTON PAYNE, CHAIRMAN
ROBERT w. DE FOREST. VICE PRESIDENT
MRS. AUGUST BELMONT
CALVIN COOLIDGE, VICE PRESIDENT
THE AMERICAN RED C
ISS
CORNELIUS N. BLISS
THOMAS D. THACHER, COUNSELOR
MABEL T BOARDMAN
JOSEPH P. COTTON
OGDEN L. MILLS, TREASURER
NATIONAL HEADQUARTERS
MRS. HENRY P. DAVISON
MABEL T. BOARDMAN, SECRETARY
E. B. DOUGLAS
WASHINGTON, D.C.
MRS. FRANK v. HAMMAR
MAJ. GEN M. w. IRELAND
NATIONAL EXECUTIVE OFFICERS
SAMUEL KNIGHT
OGDEN L. MILLS
JOHN BARTON PAYNE, CHAIRMAN
9/10/45
GUSTAVUS D. POPE
JAMES L. FIESER, VICE CHAIRMAN
MRS. HENRY R. REA
ERNEST P. BICKNELL, VICE CHAIRMAN
REAR ADMIRAL CHARLES E. RIGGS
JOHN D, RYAN
JAMES K. MCCLINTOCK. VICE CHAIRMAN
GEORGE E, SCOTT
THOMAS D. THACHER
ELIOT WADSWORTH
at
Dear Madam:
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
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:
Yours sincerely,
In order to render prompt service
Chairman or
in time of disaster, enrolled Red Cross
Olive M. Diederich, R. N.
Secretary
nurses should report at once to the
2157 Euc id Avenue
Secretary of the Local Committee under
Cleveland, 0.
Local Committee.
which they are enrolled. Do not forget
the address of the Secretary.
Name in full
majorie Zawlon Denison
If married, give husband's name
Ement Lee
Permanent address
(STREET,
21 mople ETC.), st. Willoughly (CITY) (COUNTY) Ghio
(STATE)
Probable address for the next year
same
(STREET, ETC.)
Telephone 643R.
No.
Willoughby (CITY) Ohio (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)
hurs H.C.Allen 505 Amith 46 rb 11. West Phuladelphia P.a (Sisti)
Underline the type of work
you are now doing: - Army - Navy - U.S.P.H. Hospital - U.S.Vet. Hospital - Public
Health Institutional Office Nurse Registrar. no work
- - Private Duty - Industrial - -
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
Would you respond to an emergency call in event of epidemic, disaster, war etc. ?
no
Hand 3 children
Badge No. 13119
Current date april 9th in 1931
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\nI\ne\nFORM 1045 REV. 1-7-30\nNATIONAL OFFICERS\nCENTRAL COMMITTEE\nHERBERT HOOVER, PRESIDENT\nJOHN BARTON PAYNE, CHAIRMAN\nROBERT w. DE FOREST. VICE PRESIDENT\nMRS. AUGUST BELMONT\nCALVIN COOLIDGE, VICE PRESIDENT\nTHE AMERICAN RED C\nISS\nCORNELIUS N. BLISS\nTHOMAS D. THACHER, COUNSELOR\nMABEL T BOARDMAN\nJOSEPH P. COTTON\nOGDEN L. MILLS, TREASURER\nNATIONAL HEADQUARTERS\nMRS. HENRY P. DAVISON\nMABEL T. BOARDMAN, SECRETARY\nE. B. DOUGLAS\nWASHINGTON, D.C.\nMRS. FRANK v. HAMMAR\nMAJ. GEN M. w. IRELAND\nNATIONAL EXECUTIVE OFFICERS\nSAMUEL KNIGHT\nOGDEN L. MILLS\nJOHN BARTON PAYNE, CHAIRMAN\n9/10/45\nGUSTAVUS D. POPE\nJAMES L. FIESER, VICE CHAIRMAN\nMRS. HENRY R. REA\nERNEST P. BICKNELL, VICE CHAIRMAN\nREAR ADMIRAL CHARLES E. RIGGS\nJOHN D, RYAN\nJAMES K. MCCLINTOCK. VICE CHAIRMAN\nGEORGE E, SCOTT\nTHOMAS D. THACHER\nELIOT WADSWORTH\nat\nDear Madam:\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\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:\nYours sincerely,\nIn order to render prompt service\nChairman or\nin time of disaster, enrolled Red Cross\nOlive M. Diederich, R. N.\nSecretary\nnurses should report at once to the\n2157 Euc id Avenue\nSecretary of the Local Committee under\nCleveland, 0.\nLocal Committee.\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nName in full\nmajorie Zawlon Denison\nIf married, give husband's name\nEment Lee\nPermanent address\n(STREET,\n21 mople ETC.), st. Willoughly (CITY) (COUNTY) Ghio\n(STATE)\nProbable address for the next year\nsame\n(STREET, ETC.)\nTelephone 643R.\nNo.\nWilloughby (CITY) Ohio (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)\nhurs H.C.Allen 505 Amith 46 rb 11. West Phuladelphia P.a (Sisti)\nUnderline the type of work\nyou are now doing: - Army - Navy - U.S.P.H. Hospital - U.S.Vet. Hospital - Public\nHealth Institutional Office Nurse Registrar. no work\n- - Private Duty - Industrial - -\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 good\nWould you respond to an emergency call in event of epidemic, disaster, war etc. ?\nno\nHand 3 children\nBadge No. 13119\nCurrent date april 9th in 1931\nNOTE. -If the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrolment will be annulled"
}