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FORM 1045
REV. 4-4-38
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. c.
0
QUESTIONNAIRES DESTABVER
Dear Red Cross Nurse:
Francisco
Fr
N
(b
-
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
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-
L
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.
a
IMPORTANT:
6
In order to render prompt service
Yours sincerely
in time of disaster, enrolled Red Cross
BEATRICE McLAREN BAIRD, Secty Chairman or
1
SANTA CLARA co. LOCAL COM.
Nurses should report at once to the
Secretary.
SANTA CLARA COT HOSPITAL
a
Secretary of the Local Committee under
SAN JOSE, CALIF.
which they are enrolled. Do not forget
Local Committee.
m
the address of the Secretary.
Name
in full Mellie Frances Labrum
-
If married, give husband's name
Permanent address 144, Gardnerd Hallywood Rosengeles Calif
(STREET, ETC.)
(CITH)
(COUNTY)
(STATE
Probable address for the next year starford Convolened Home
(STREET, ETC.)
Telephone No. 6158
Pala atto South Claim
Calif
(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)
clayton, friend Stanford Convelescent Home, Palaalto
Underline the Ctype 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? 30
Have you ever been?
no
Would you like to teach Red Cross classes? 30
Indicate present physical condition
Good
Would you respond to an emergency event
call in of epidemic, disaster, war, etc. ? yes
Badge No.
68072
Current date march 12, 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.
2
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"ocrText": "Z\nI\nee\na\ne\nI\nE\nFORM 1045\nREV. 4-4-38\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. c.\n0\nQUESTIONNAIRES DESTABVER\nDear Red Cross Nurse:\nFrancisco\nFr\nN\n(b\n-\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\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-\nL\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.\na\nIMPORTANT:\n6\nIn order to render prompt service\nYours sincerely\nin time of disaster, enrolled Red Cross\nBEATRICE McLAREN BAIRD, Secty Chairman or\n1\nSANTA CLARA co. LOCAL COM.\nNurses should report at once to the\nSecretary.\nSANTA CLARA COT HOSPITAL\na\nSecretary of the Local Committee under\nSAN JOSE, CALIF.\nwhich they are enrolled. Do not forget\nLocal Committee.\nm\nthe address of the Secretary.\nName\nin full Mellie Frances Labrum\n-\nIf married, give husband's name\nPermanent address 144, Gardnerd Hallywood Rosengeles Calif\n(STREET, ETC.)\n(CITH)\n(COUNTY)\n(STATE\nProbable address for the next year starford Convolened Home\n(STREET, ETC.)\nTelephone No. 6158\nPala atto South Claim\nCalif\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)\nclayton, friend Stanford Convelescent Home, Palaalto\nUnderline the Ctype 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? 30\nHave you ever been?\nno\nWould you like to teach Red Cross classes? 30\nIndicate present physical condition\nGood\nWould you respond to an emergency event\ncall in of epidemic, disaster, war, etc. ? yes\nBadge No.\n68072\nCurrent date march 12, 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.\n2"
}