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FORM 1045
REV. 4-4-38
THE AMERICAN RED CROSS
D
-
NATIONAL HEADQUARTERS
WASHINGTON, D. C.
L
a
L
e
Dear Red Cross Nurse:
a
5
The National Committee on Red Cross Nursing Service requires us to submit,
a
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-
F
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.
S
IMPORTANT:
In order to render prompt service
Yours sincerely,
in time of disaster, enrolled Red Cross
Nurses should report at once to the
miriam C Schaupp R. n
Chairman or
Secretary.
Secretary of the Local Committee under
which they are enrolled. Do not forget
atlanta Heargian Local Committee.
the address of the Secretary.
Name in full Misshaverna Fish Harvard
If married, give husband': name
Permanent address 204 Church St Dublin (CITY) Laurens (COUNTY) Georgia
(STREET. ETC.)
(STATE)
Probable address for the next year
Emary (STREET, ETC.) Hospital
University
Telephone No. Je6200
Emary (CITY) University Mekall (COUNTY)
Georgia
(STATE)
Name and address of nearest relative or friend, in United States, through whom you may
be communicated with in an emergency. (State relationship)
Mrs Alice H Brinson 204Church St Dublin 9a. (Sister)
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 Hygiene and Care the
of Red Cross classes in Home of Sick? no
Have you ever been? no
Would you like to teach Red Cross classes? Yes
Indicate present physical good
condition
W
Would you respond emergency call in of epidemic, disaster, war, etc.? Yes
to an event
8
Badge No. 38820
Current date
Feb-17-1934
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\nar\nT\nL\na\n1\nFORM 1045\nREV. 4-4-38\nTHE AMERICAN RED CROSS\nD\n-\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\nL\na\nL\ne\nDear Red Cross Nurse:\na\n5\nThe National Committee on Red Cross Nursing Service requires us to submit,\na\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-\nF\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.\nS\nIMPORTANT:\nIn order to render prompt service\nYours sincerely,\nin time of disaster, enrolled Red Cross\nNurses should report at once to the\nmiriam C Schaupp R. n\nChairman or\nSecretary.\nSecretary of the Local Committee under\nwhich they are enrolled. Do not forget\natlanta Heargian Local Committee.\nthe address of the Secretary.\nName in full Misshaverna Fish Harvard\nIf married, give husband': name\nPermanent address 204 Church St Dublin (CITY) Laurens (COUNTY) Georgia\n(STREET. ETC.)\n(STATE)\nProbable address for the next year\nEmary (STREET, ETC.) Hospital\nUniversity\nTelephone No. Je6200\nEmary (CITY) University Mekall (COUNTY)\nGeorgia\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)\nMrs Alice H Brinson 204Church St Dublin 9a. (Sister)\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 Hygiene and Care the\nof Red Cross classes in Home of Sick? no\nHave you ever been? no\nWould you like to teach Red Cross classes? Yes\nIndicate present physical good\ncondition\nW\nWould you respond emergency call in of epidemic, disaster, war, etc.? Yes\nto an event\n8\nBadge No. 38820\nCurrent date\nFeb-17-1934\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."
}