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RED CROSS BADGE NUMBER
K
AMERICAN RED CROSS
5274
NURSING SERVICES
MILITARY SERIAL NUMBER
K
?
ANNUAL QUESTIONNAIRE - 1945
CHECK IF YOUR LAST NAME HAS CHANGED
+
NAME (Last, first, middle)
TELEPHONE NO.
5
Elder Kattearier macklin
Catons 1197
IF MARRIED, GIVE MAIDEN) NAME,
HUSBAND'S NAME
Kathanue macklin
Dr. John David Elder
PERMANENT ADDRESS (Street, city, zone, county, state)
200 montrose ave., state) Cotonsville, 28, marylaud
PRESENT ADDRESS. (Street, city, zone, county,
NAME AND ADDRESS OF NEAREST RELATIVE OB
wr Welder t Dr FRIEND Welder for IN THE UNITED STATES
RELATIONSHIP
sour as above
husbased son
DATE OF BIRTH (Month, day, year)
Single
Married
Separated
Widowed
Divorced
WHAT LANGUAGES DO YOU SPEAK?
Euplish, groman Crabic.
YES
NO
HIGH SCHOOL GRADUATE
1.AME OF COLLEGE OR
Packard LOCATION nychi INCLUSIVE
DEGREE OR
UNIVERSITY ATTENDED
DATES
DIPLOMA
MAJOR
-
ARE YOU CURRENTLY
YES
NO
REGISTERED IN (State)
ARE YOU CURRENTLY A MEMBER OF THE AMERICAN
YES
NO
REGISTERED?
yes
NURSES' ASSOCIATION?
PRESENT EMPLOYMENT If not employed, check
POSITION TITLE (H.N. P.D. inst., staff nurse, etc.)
SERVICE (Medicine, surgery, etc.)
NAME OF HOSPITAL OR ORGANIZATION BY
staff
not WHOM EMPLOYED Employed
CITY
STATE
HEALTH
IF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY
ors age
VOLUNTEER SERVICE
The purpose of the following statements is to identify the nurses who can 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 wi Liling and able to
serve if called on within the next 12 sonths.
NAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS Batheroo
1. Teach home
YES
NO
Attend an instructors' training program, if offered. (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 disaster
In other communities
offered, in preparation for service
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?
no
IF
UNABLE
TO
SERVE,
GIVE
MAJOR
REASONS
house responsibilities - ottrage
DATE
8/15/45
S IGNATURE
"Kathanur m. Elder.
YOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR PAITHPOLNESS IN
KEEPING US INFORNSC OF YOUR ADDRESS. PLEASE PILL IN THIS QUESTIONWAIRE AND RETURN If PROMPTLY TO THE
COMMITTES NAMED BELOW.
ATTENTION
Fill in committee name
SECRETARY
NURSE RECRUITMENT
COMMITTEE
V. Mt. Vernon Place
J
Md.
504M
FORM 1045 Rev. July 1945
Page data
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- Type
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Document data
- ID
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- Core
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- Type
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DTO data
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Context sent to Scholar
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"ocrText": "Z\n&\n-\n6\na\neT\ne\nRED CROSS BADGE NUMBER\nK\nAMERICAN RED CROSS\n5274\nNURSING SERVICES\nMILITARY SERIAL NUMBER\nK\n?\nANNUAL QUESTIONNAIRE - 1945\nCHECK IF YOUR LAST NAME HAS CHANGED\n+\nNAME (Last, first, middle)\nTELEPHONE NO.\n5\nElder Kattearier macklin\nCatons 1197\nIF MARRIED, GIVE MAIDEN) NAME,\nHUSBAND'S NAME\nKathanue macklin\nDr. John David Elder\nPERMANENT ADDRESS (Street, city, zone, county, state)\n200 montrose ave., state) Cotonsville, 28, marylaud\nPRESENT ADDRESS. (Street, city, zone, county,\nNAME AND ADDRESS OF NEAREST RELATIVE OB\nwr Welder t Dr FRIEND Welder for IN THE UNITED STATES\nRELATIONSHIP\nsour as above\nhusbased son\nDATE OF BIRTH (Month, day, year)\nSingle\nMarried\nSeparated\nWidowed\nDivorced\nWHAT LANGUAGES DO YOU SPEAK?\nEuplish, groman Crabic.\nYES\nNO\nHIGH SCHOOL GRADUATE\n1.AME OF COLLEGE OR\nPackard LOCATION nychi INCLUSIVE\nDEGREE OR\nUNIVERSITY ATTENDED\nDATES\nDIPLOMA\nMAJOR\n-\nARE YOU CURRENTLY\nYES\nNO\nREGISTERED IN (State)\nARE YOU CURRENTLY A MEMBER OF THE AMERICAN\nYES\nNO\nREGISTERED?\nyes\nNURSES' ASSOCIATION?\nPRESENT EMPLOYMENT If not employed, check\nPOSITION TITLE (H.N. P.D. inst., staff nurse, etc.)\nSERVICE (Medicine, surgery, etc.)\nNAME OF HOSPITAL OR ORGANIZATION BY\nstaff\nnot WHOM EMPLOYED Employed\nCITY\nSTATE\nHEALTH\nIF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY\nors age\nVOLUNTEER SERVICE\nThe purpose of the following statements is to identify the nurses who can 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 wi Liling and able to\nserve if called on within the next 12 sonths.\nNAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS Batheroo\n1. Teach home\nYES\nNO\nAttend an instructors' training program, if offered. (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 disaster\nIn other communities\noffered, in preparation for service\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?\nno\nIF\nUNABLE\nTO\nSERVE,\nGIVE\nMAJOR\nREASONS\nhouse responsibilities - ottrage\nDATE\n8/15/45\nS IGNATURE\n\"Kathanur m. Elder.\nYOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR PAITHPOLNESS IN\nKEEPING US INFORNSC OF YOUR ADDRESS. PLEASE PILL IN THIS QUESTIONWAIRE AND RETURN If PROMPTLY TO THE\nCOMMITTES NAMED BELOW.\nATTENTION\nFill in committee name\nSECRETARY\nNURSE RECRUITMENT\nCOMMITTEE\nV. Mt. Vernon Place\nJ\nMd.\n504M\nFORM 1045 Rev. July 1945"
}