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FORM 1045 REV. 2-16-31
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 CROSS
CORNELIUS N. BLISS
MABEL T. BOARDMAN
CHARLES EVANS HUGHES. VICE PRESIDENT
JOSEPH P. COTTON
THOMAS D. THACHER, COUNSELOR
NATIONAL HEADQUARTERS
MRS. HENRY P. DAVISON
OGDEN L. MILLS. TREASURER
MRS. FRANK v. HAMMAR
WASHINGTON, D. C.
MAJ. GEN. M. w. IRELAND
MABEL T. BOARDMAN, SECRETARY
SAMUEL KNIGHT
OGDEN L. MILLS
NATIONAL EXECUTIVE OFFICERS
GUSTAVUS D. POPE
MRS. HENRY R. REA
JOHN BARTON PAYNE. CHAIRMAN
REAR ADMIRAL CHARLES E. RIGGS
JOHN D. RYAN
JAMES L. FIESER, VICE CHAIRMAN
ERNEST P. BICKNELL, VICE CHAIRMAN
JAMES K. MCCLINTOCK, VICE CHAIRMAN
2-27-33. Coffeed of and Revenue,
GEORGE E. SCOTT
HENRY UPSON SIMS
THOMAS D. THACHER
ELIOT WADSWORTH
11 QUESTIONNAIRES DESTROYED
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:
In order to render prompt service
Yours sincerely,
in time of disaster, enrolled Red Cross
Mrs. Ferne G. Goodwin
Chairman or
Nurses should report at once to the
Secy. State and Local Committee,
Secretary.
Secretary of the Local Committee under
Red Cross Nursing Service,
which they are enrolled. Do not forget
22. SCHOOL STREET
Local Committee.
the address of the Secretary.
BRUNSWICK
MAINE
Name in full (mms) Thrence McCandless Dow
If married, give husband's name Haroed Chester Dow
Permanent address 451 STREET, ETC. CITY So.Pretand COUNTY Class mane STATE
Heghland he
Probable address for the next year 451 Highland STREET, are ETC. So Poeland me
Telephone No Forest 56 05
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)
misalfred P.Lee 4713 Sprungfield Ane, Phila Perra
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 good
Would you respond to an emergency call in event of
epidemic, disaster, war, etc.? yes
Badge No. 5311
Current date
march 6 - 1933
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": "FORM 1045 REV. 2-16-31\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 CROSS\nCORNELIUS N. BLISS\nMABEL T. BOARDMAN\nCHARLES EVANS HUGHES. VICE PRESIDENT\nJOSEPH P. COTTON\nTHOMAS D. THACHER, COUNSELOR\nNATIONAL HEADQUARTERS\nMRS. HENRY P. DAVISON\nOGDEN L. MILLS. TREASURER\nMRS. FRANK v. HAMMAR\nWASHINGTON, D. C.\nMAJ. GEN. M. w. IRELAND\nMABEL T. BOARDMAN, SECRETARY\nSAMUEL KNIGHT\nOGDEN L. MILLS\nNATIONAL EXECUTIVE OFFICERS\nGUSTAVUS D. POPE\nMRS. HENRY R. REA\nJOHN BARTON PAYNE. CHAIRMAN\nREAR ADMIRAL CHARLES E. RIGGS\nJOHN D. RYAN\nJAMES L. FIESER, VICE CHAIRMAN\nERNEST P. BICKNELL, VICE CHAIRMAN\nJAMES K. MCCLINTOCK, VICE CHAIRMAN\n2-27-33. Coffeed of and Revenue,\nGEORGE E. SCOTT\nHENRY UPSON SIMS\nTHOMAS D. THACHER\nELIOT WADSWORTH\n11 QUESTIONNAIRES DESTROYED\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:\nIn order to render prompt service\nYours sincerely,\nin time of disaster, enrolled Red Cross\nMrs. Ferne G. Goodwin\nChairman or\nNurses should report at once to the\nSecy. State and Local Committee,\nSecretary.\nSecretary of the Local Committee under\nRed Cross Nursing Service,\nwhich they are enrolled. Do not forget\n22. SCHOOL STREET\nLocal Committee.\nthe address of the Secretary.\nBRUNSWICK\nMAINE\nName in full (mms) Thrence McCandless Dow\nIf married, give husband's name Haroed Chester Dow\nPermanent address 451 STREET, ETC. CITY So.Pretand COUNTY Class mane STATE\nHeghland he\nProbable address for the next year 451 Highland STREET, are ETC. So Poeland me\nTelephone No Forest 56 05\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)\nmisalfred P.Lee 4713 Sprungfield Ane, Phila Perra\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? no\nHave you ever been?\nyes\nIndicate present physical condition good\nWould you respond to an emergency call in event of\nepidemic, disaster, war, etc.? yes\nBadge No. 5311\nCurrent date\nmarch 6 - 1933\nNOTE.-If the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrolment will be annulled."
}