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C
K
FORM 1045
THE AMERICAN RED CROSS
REV. 1-2.35
NATIONAL HEADQUARTERS
a
WASHINGTON, D. c.
a
a
e
Dear Madam:
5
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:
In order to render prompt service
Yours sincerely,
in time of disaster, enrolled Red Cross
Chairman or
Nurses should report at once to the
FLORENCE M. JOHNSON
Secretary.
Secretary of the Local Committee under
MANHATTAN
which they are enrolled. Do not forget
Local Committee.
the address of the Secretary.
Name in full
Uedda 7 Hictorox
If married, give husband's name
Permanent address 1320 york are new yonk newyork newyork
(STREET,
(CITY)
(COUNTY)
(STATE)
Probable address for the next year
some
(STREET, ETC.)
Telephone No. Regard 4-6000
(CITY)
(COUNTY)
(STATE)
Name and address of nearest relative or friend, in United States, through whom you may
Sister
be communicated with in an emergency. (State relationship)
mrs Jules Klosterman 40 meaplerood An Bagota newjors.
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? No
Have you ever been?
yes
Indicate present physical condition
good
Would respond emergency epidemic, disaster, war, etc. ? yrs
you to an call in event of
Badge No. 15445
Current
date April 4 1937
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": "C\nK\nFORM 1045\nTHE AMERICAN RED CROSS\nREV. 1-2.35\nNATIONAL HEADQUARTERS\na\nWASHINGTON, D. c.\na\na\ne\nDear Madam:\n5\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:\nIn order to render prompt service\nYours sincerely,\nin time of disaster, enrolled Red Cross\nChairman or\nNurses should report at once to the\nFLORENCE M. JOHNSON\nSecretary.\nSecretary of the Local Committee under\nMANHATTAN\nwhich they are enrolled. Do not forget\nLocal Committee.\nthe address of the Secretary.\nName in full\nUedda 7 Hictorox\nIf married, give husband's name\nPermanent address 1320 york are new yonk newyork newyork\n(STREET,\n(CITY)\n(COUNTY)\n(STATE)\nProbable address for the next year\nsome\n(STREET, ETC.)\nTelephone No. Regard 4-6000\n(CITY)\n(COUNTY)\n(STATE)\nName and address of nearest relative or friend, in United States, through whom you may\nSister\nbe communicated with in an emergency. (State relationship)\nmrs Jules Klosterman 40 meaplerood An Bagota newjors.\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? No\nHave you ever been?\nyes\nIndicate present physical condition\ngood\nWould respond emergency epidemic, disaster, war, etc. ? yrs\nyou to an call in event of\nBadge No. 15445\nCurrent\ndate April 4 1937\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."
}