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e
FORM 1045
K
REV. 4-4-38
THE AMERICAN RED CROSS
us
J
NATIONAL HEADQUARTERS
a
WASHINGTON, D. C.
Dear Red Cross Nurse:
S.
a
The National Committee on Red Cross Nursing Service requires us to submit,
5
annually, a report of all the Red Cross Nurses enrolled with our Committee. Will you
C
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-
S.
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.
Me
IMPORTANT:
S,
In order to render prompt service
Yours sincerely
in time of disaster, enrolled Red Cross
Nurses should report at once to the
Chairman-or Secretary.
Secretary of the Local Committee under
which they are enrolled. Do not forget
DIST OF COLUMBIA Local Committee.
the address of the Secretary.
Name in full Juliana Thompson Kuqua 70 wle
If
married, give husband's name Frederick E. Fowle
Permanent address wash (CITY)
2919940
D.C
(STREET, ETC.)
(COUNTY)
(STATE)
Probable address for the next year
Same as above
(STREET, ETC.)
Telephone No. Du 7322
(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-mestalfed Harper - Red LaKe Falls, minn.
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
Would you like to teach Red Cross classes?
Indicate present physical condition Good
Would
you respond to an emergency call in event of epidemic, disaster, war, etc.' formble
Badge No.
9304
Current date
march 1939
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.
Page data
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- Type
- photo
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- 28c0ad8b6396767a
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Document data
- ID
- 2661486
- Core
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- Type
- document
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Context sent to Scholar
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"ocrText": "F\ne\nFORM 1045\nK\nREV. 4-4-38\nTHE AMERICAN RED CROSS\nus\nJ\nNATIONAL HEADQUARTERS\na\nWASHINGTON, D. C.\nDear Red Cross Nurse:\nS.\na\nThe National Committee on Red Cross Nursing Service requires us to submit,\n5\nannually, a report of all the Red Cross Nurses enrolled with our Committee. Will you\nC\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-\nS.\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.\nMe\nIMPORTANT:\nS,\nIn order to render prompt service\nYours sincerely\nin time of disaster, enrolled Red Cross\nNurses should report at once to the\nChairman-or Secretary.\nSecretary of the Local Committee under\nwhich they are enrolled. Do not forget\nDIST OF COLUMBIA Local Committee.\nthe address of the Secretary.\nName in full Juliana Thompson Kuqua 70 wle\nIf\nmarried, give husband's name Frederick E. Fowle\nPermanent address wash (CITY)\n2919940\nD.C\n(STREET, ETC.)\n(COUNTY)\n(STATE)\nProbable address for the next year\nSame as above\n(STREET, ETC.)\nTelephone No. Du 7322\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)\nSister-mestalfed Harper - Red LaKe Falls, minn.\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? no\nHave you ever been? no\nWould you like to teach Red Cross classes?\nIndicate present physical condition Good\nWould\nyou respond to an emergency call in event of epidemic, disaster, war, etc.' formble\nBadge No.\n9304\nCurrent date\nmarch 1939\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."
}