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FORM 1045
REV. 4-4-38
THE AMERICAN RED CROSS
1st
M
NATIONAL HEADQUARTERS
WASHINGTON, D. C.
ar
+
L
a
D
Dear Red Cross Nurse:
The National Committee on Red Cross Nursing Service requires us to submit,
annually, a report of all the Red Cross Nurses enrolled with our Committee. Will you
e
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
1
WITH YOUR RECORDS AT NATIONAL HEADQUARTERS IN WASHINGTON, D. C. We hope you will rec-
5
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.
e
IMPORTANT:
Yours sincerely,
In order to render prompt service
Chairman or
in time of disaster, enrolled Red Cross
Miss Emilie G. Robson,
Secretary.
Nurses should report at once to the
Red Cross: Nursing Committee
Secretary of the Local Committee under
3723 Olive St., St. Louis, Mo.
Local Committee.
which they are enrolled. Do not- forget
the address of the Secretary.
Name in full Trioux, Martha alleyan
-
If married, give husband's name
Permanent address 223 N.South (STREET. ETC.) Pensyille SCITY) Perry (CQUNTY)
Missouri
(STATE)
Probable address for the next year\
419 E 8th street
(STREET, ETC.),
Telephone No.
2-4820
Little Rock Pulaski (COUNTY)
arkansas
(STATE)
(CITY)
Name and address of nearest relative or friend, in United States, through whom you may
be communicated with in an emergency. (State relationship)
Mother) Missfunette Trianx 523 N South Pennynille Me-
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 of Red Cross classes in Home Hygiene and Care of the Sick? No
Have you ever
you an instructor been? yes Would you like to teach Red Cross classes? yew
Indicate present physical condition Good
Would you respond to an emergency call in event of epidemic, disaster, war, yes
Badge No. 59029
Current date again a 1940
NOTE.- -If the nurse does not complete and return this questionnaire, and can not be
0
located within two years, her enrolment will be removed from our active files.
v
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"ocrText": "a\nx\nFORM 1045\nREV. 4-4-38\nTHE AMERICAN RED CROSS\n1st\nM\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\nar\n+\nL\na\nD\nDear Red Cross Nurse:\nThe National Committee on Red Cross Nursing Service requires us to submit,\nannually, a report of all the Red Cross Nurses enrolled with our Committee. Will you\ne\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\n1\nWITH YOUR RECORDS AT NATIONAL HEADQUARTERS IN WASHINGTON, D. C. We hope you will rec-\n5\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.\ne\nIMPORTANT:\nYours sincerely,\nIn order to render prompt service\nChairman or\nin time of disaster, enrolled Red Cross\nMiss Emilie G. Robson,\nSecretary.\nNurses should report at once to the\nRed Cross: Nursing Committee\nSecretary of the Local Committee under\n3723 Olive St., St. Louis, Mo.\nLocal Committee.\nwhich they are enrolled. Do not- forget\nthe address of the Secretary.\nName in full Trioux, Martha alleyan\n-\nIf married, give husband's name\nPermanent address 223 N.South (STREET. ETC.) Pensyille SCITY) Perry (CQUNTY)\nMissouri\n(STATE)\nProbable address for the next year\\\n419 E 8th street\n(STREET, ETC.),\nTelephone No.\n2-4820\nLittle Rock Pulaski (COUNTY)\narkansas\n(STATE)\n(CITY)\nName and address of nearest relative or friend, in United States, through whom you may\nbe communicated with in an emergency. (State relationship)\nMother) Missfunette Trianx 523 N South Pennynille Me-\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 of Red Cross classes in Home Hygiene and Care of the Sick? No\nHave you ever\nyou an instructor been? yes Would you like to teach Red Cross classes? yew\nIndicate present physical condition Good\nWould you respond to an emergency call in event of epidemic, disaster, war, yes\nBadge No. 59029\nCurrent date again a 1940\nNOTE.- -If the nurse does not complete and return this questionnaire, and can not be\n0\nlocated within two years, her enrolment will be removed from our active files.\nv"
}