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FORM 1045 REV. 2-16-31
NATIONAL OFFICERS
CENTRAL COMMITTEE
HERBERT HOOVER, PRESIDENT
JOHN BARTON PAYNE, CHAIRMAN
M
MRS. AUGUST BELMONT
ROBERT w. DE FOREST, VICE PRESIDENT
CALVIN COOLIDGE, VICE PRESIDENT
THE AMERICAN RED CROSS
CORNELIUS N. BLISS
MABEL T. BOARDMAN
JOSEPH P. COTTON
a
M
CHARLES EVANS HUGHES, VICE PRESIDENT
THOMAS D. THACHER, COUNSELOR
NATIONAL HEADQUARTERS
MRS. HENRY P. DAVISON
MRS. FRANK v. HAMMAR
OGDEN L. MILLS, TREASURER
MAJ. GEN. M. w. IRELAND
I
WASHINGTON, D.C.
MABEL T. BOARDMAN, SECRETARY
SAMUEL KNIGHT
OGDEN L. MILLS
-
S
GUSTAVUS D. POPE
NATIONAL EXECUTIVE OFFICERS
MRS, HENRY R. REA
REAR ADMIRAL CHARLES E. RIGGS
a
JOHN BARTON PAYNE, CHAIRMAN
JOHN D. RYAN
JAMES L. FIESER, VICE CHAIRMAN
GEORGE E, SCOTT
a
HENRY UPSON SIMS
ERNEST P. BICKNELL, VICE CHAIRMAN
THOMAS D. THACHER
M
JAMES K. MCCLINTOCK, VICE CHAIRMAN
ELIOT WADSWORTH
C
a
+
on
Dear Madam:
{
a
a
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,
3
In order to render prompt service
Chairman or
in time of disaster, enrolled Red Cross
F. ELNA SMITTEN:
Secretary.
Nurses should report at once to the
Secretary Local Committee
Secretary of the Local Committee under
RED CROSS NURSING SERVICE
Local Committee.
which they are enrolled. Do not forget
Chamber of Commerce Bldg.
the address of the Secretary.
PITTSBURGH, PA.
Name in full
Matilda Conn now (mos) m S. Feemley
If
married, give husband's name melvin S. Falmley
Permanent
address 44 STREET, Broadway ETC. St CITY n. Iwwn Westmoneland., COUNTY STATE Penna
Probable address for the next year
same
STREET, ETC.
Telephone No.
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)
(Sister) ms Aley geddes - 150 East, 35th st. new york City n.y
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?
no
Indicate present physical condition
good
Would you respond to an emergency call in event of epidemic, disaster, war, etc.?
Badge No. 23,709
Current date
april 9th th 1932
NOTE. -If the nurse does not complete and return this questionnaire, and can not be
located within two years, her enrolment will be annulled.
3nd Resure family responsibilities
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"ocrText": "F\nto\nI\net\nm\nFORM 1045 REV. 2-16-31\nNATIONAL OFFICERS\nCENTRAL COMMITTEE\nHERBERT HOOVER, PRESIDENT\nJOHN BARTON PAYNE, CHAIRMAN\nM\nMRS. AUGUST BELMONT\nROBERT w. DE FOREST, VICE PRESIDENT\nCALVIN COOLIDGE, VICE PRESIDENT\nTHE AMERICAN RED CROSS\nCORNELIUS N. BLISS\nMABEL T. BOARDMAN\nJOSEPH P. COTTON\na\nM\nCHARLES EVANS HUGHES, VICE PRESIDENT\nTHOMAS D. THACHER, COUNSELOR\nNATIONAL HEADQUARTERS\nMRS. HENRY P. DAVISON\nMRS. FRANK v. HAMMAR\nOGDEN L. MILLS, TREASURER\nMAJ. GEN. M. w. IRELAND\nI\nWASHINGTON, D.C.\nMABEL T. BOARDMAN, SECRETARY\nSAMUEL KNIGHT\nOGDEN L. MILLS\n-\nS\nGUSTAVUS D. POPE\nNATIONAL EXECUTIVE OFFICERS\nMRS, HENRY R. REA\nREAR ADMIRAL CHARLES E. RIGGS\na\nJOHN BARTON PAYNE, CHAIRMAN\nJOHN D. RYAN\nJAMES L. FIESER, VICE CHAIRMAN\nGEORGE E, SCOTT\na\nHENRY UPSON SIMS\nERNEST P. BICKNELL, VICE CHAIRMAN\nTHOMAS D. THACHER\nM\nJAMES K. MCCLINTOCK, VICE CHAIRMAN\nELIOT WADSWORTH\nC\na\n+\non\nDear Madam:\n{\na\na\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,\n3\nIn order to render prompt service\nChairman or\nin time of disaster, enrolled Red Cross\nF. ELNA SMITTEN:\nSecretary.\nNurses should report at once to the\nSecretary Local Committee\nSecretary of the Local Committee under\nRED CROSS NURSING SERVICE\nLocal Committee.\nwhich they are enrolled. Do not forget\nChamber of Commerce Bldg.\nthe address of the Secretary.\nPITTSBURGH, PA.\nName in full\nMatilda Conn now (mos) m S. Feemley\nIf\nmarried, give husband's name melvin S. Falmley\nPermanent\naddress 44 STREET, Broadway ETC. St CITY n. Iwwn Westmoneland., COUNTY STATE Penna\nProbable address for the next year\nsame\nSTREET, ETC.\nTelephone No.\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)\n(Sister) ms Aley geddes - 150 East, 35th st. new york City n.y\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?\nno\nIndicate present physical condition\ngood\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.?\nBadge No. 23,709\nCurrent date\napril 9th th 1932\nNOTE. -If the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrolment will be annulled.\n3nd Resure family responsibilities"
}