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I FORM 1045 REV. 4-4-38 THE AMERICAN RED CROSS NATIONAL HEADQUARTERS e WASHINGTON, D. c. F 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 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: Yours sincerely, In order to render prompt service Chairman or in time of disaster, enrolled Red Cross PLORENCE M. JOHNSON Secretary. Nurses should report at once to the MANNATTAN Secretary of the Local Committee under Local Committee. which they are enrolled. Do not forget the address of the Secretary. Name in full VERDA F. HICKCOX - If married, give husband's name Permanent address 1320 Yorhan New (dity) York NewYork New York (STREET ETC.) (COUNTY) (STATE) Probable address for the next year as above (STREET. ETC.) Telephone No. Regent 4-6000 (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 - Mrs. Jule Klasterman 40 Maplewood Ave Bogota, N.J Underline the type of work you are now doing: Army - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service - Public Health - Institptional - 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? yes Would you like to teach Red Cross classes? No Indicate present physical condition good 4 Would you to an call event of respond emergency in epidemic, disaster, war, etc.? IS necessary Badge No. 15445 Current date march 15 1939 5T 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\nFORM 1045\nREV. 4-4-38\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\ne\nWASHINGTON, D. c.\nF\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\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:\nYours sincerely,\nIn order to render prompt service\nChairman or\nin time of disaster, enrolled Red Cross\nPLORENCE M. JOHNSON\nSecretary.\nNurses should report at once to the\nMANNATTAN\nSecretary of the Local Committee under\nLocal Committee.\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nName in full\nVERDA F. HICKCOX\n-\nIf married, give husband's name\nPermanent address 1320 Yorhan New (dity) York\nNewYork\nNew York\n(STREET ETC.)\n(COUNTY)\n(STATE)\nProbable address for the next year\nas above\n(STREET. ETC.)\nTelephone No. Regent 4-6000\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 - Mrs. Jule Klasterman 40 Maplewood Ave Bogota, N.J\nUnderline the type of work you are now doing:\nArmy - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service -\nPublic Health - Institptional - Private Duty - Industrial - Office Nurse - Registrar.\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick?\nNo\nHave you ever been? yes\nWould you like to teach Red Cross classes?\nNo\nIndicate present physical condition\ngood\n4\nWould you to an call event of\nrespond emergency in epidemic, disaster, war, etc.? IS necessary\nBadge No. 15445\nCurrent date march 15 1939\n5T\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."
}