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FORM 1045
REV. 4-4-38
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
M
WASHINGTON, D. C.
A
-
Dear Red Cross Nurse:
The National Committee on Red Cross Nursing Service requires us to submit,
e
annually, a report of all the Red Cross Nurses enrolled with our Committee. Will you
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-
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.
IMPORTANT:
In order to render prompt service
Yours sincerely,
in time of disaster, enrolled Red Cross
Chairman or
Nurses should report at once to the
mary Callarie
Secretary.
Secretary of the Local Committee under
which they are enrolled. Do not forget
the address of the Secretary.
montgomery, ala Local Committee.
Name in full mary Alice Harrie
If married, give husband's name
single
Permanent address Claston (STREET,ETC) ala Boy (CITY) 156 Barbour (COUNTY) (als) (STATE)
Probable address for the next year same as above
(STREET, E/TC.)
Telephone No. 180 of
Clayton
Barbour
ala
ACITY)
(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)
drine Davis Susenby 1400 West main st Dathan, ala
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? yes
Have you ever been? yes
Would you like to teach Red Cross classes? S do
Indicate present physical condition Good
Would you to an event ?
on for send you to look
respond emergency call in of epidemic, disaster, war, etc. yes
Badge No. 62,247
m
Current date 1-6.39
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.
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"ocrText": "I\na\na\nbust\nFORM 1045\nREV. 4-4-38\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nM\nWASHINGTON, D. C.\nA\n-\nDear Red Cross Nurse:\nThe National Committee on Red Cross Nursing Service requires us to submit,\ne\nannually, a report of all the Red Cross Nurses enrolled with our Committee. Will you\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-\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.\nIMPORTANT:\nIn order to render prompt service\nYours sincerely,\nin time of disaster, enrolled Red Cross\nChairman or\nNurses should report at once to the\nmary Callarie\nSecretary.\nSecretary of the Local Committee under\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nmontgomery, ala Local Committee.\nName in full mary Alice Harrie\nIf married, give husband's name\nsingle\nPermanent address Claston (STREET,ETC) ala Boy (CITY) 156 Barbour (COUNTY) (als) (STATE)\nProbable address for the next year same as above\n(STREET, E/TC.)\nTelephone No. 180 of\nClayton\nBarbour\nala\nACITY)\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)\ndrine Davis Susenby 1400 West main st Dathan, ala\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? yes\nHave you ever been? yes\nWould you like to teach Red Cross classes? S do\nIndicate present physical condition Good\nWould you to an event ?\non for send you to look\nrespond emergency call in of epidemic, disaster, war, etc. yes\nBadge No. 62,247\nm\nCurrent date 1-6.39\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."
}