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Form 1045 Rev. 1-7-30
NATIONAL OFFICERS
CENTRAL COMMITTEE
MERBERT HOOVER, PRESIDENT
ROBERT w. DE ROREST. VICE PRESIDENT
JOHN BARTON PAYNE CHAIRMAN
MRS. AUGUST BELMONT
WILLIAM HOWARD TAFT, VICE PRESIDENT
CALVIN COOLIDGE, VICE PRESIDENT
THE AMERICAN RED CROSS
CORNELIUS N. BLISS
MABEL T. BOARDMAN
CHARLES EVANS HUGHES, JR., COUNSELOR
JOSEPH P COTTON
NATIONAL HEADQUARTERS
MRS. HENRY P. DAVISON
OGDEN L. MILLS, TREASURER
E. B. DOUGLAS
MABEL T. BOARDMAN. SECRETARY
WASHINGTON, D. C.
MRS. FRANK v. HAMMAR
CHARLES EVANS HUGHES, JR.
MAJ. GEN. M. w. IRELAND
NATIONAL EXECUTIVE OFFICERS
SAMUEL KNIGHT
OGDEN L. MILLS
JOHN BARTON PAYNE, CHAIRMAN
GUSTAVUS D. POPE
JAMES L. FIESER, VICE CHAIRMAN
MRS, HENRY R. REA
REAR ADMIRAL CHARLES E. RIGGS
ERNEST P. BICKNELL, VICE CHAIRMAN
JOHN D, RYAN
JAMES K. McCLINTOCK, VICE CHAIRMAN
GEORGE E, SCOTT
a
ELIOT WADSWORTH
5
Dear Madam:
The National Committee on Red Cross Nursing Service requires us to submit,
annually, a list of all the Red Cross Nurses enrolled with our Committee, with their
latest addresses. We are extremely anxious to make a very complete report to National
Headquarters and ask for your cooperation. Please answer the following questions and
return this form to me, in enclosed envelope, at the earliest possible date.
IMPORTANT:
Yours sincerely,
In order to render prompt service
Chairman or
in time of disaster, enrolled Red Cross
EDNA C. MOAG
nurses should report at once to the
Secretary.
SECRETARY, LOCAL COMMITTEE
Secretary of the Local Committee under
RED CROSS NURSING SERVICE Local Committee.
which they are enrolled. Do not forget
130 CLINTON STREET
the address of the-Secretary.
BROOKLYN, N. Y,
Name in full
Jane Eligabeth Hitchcock
If married, give husband's name
m-married
Permanent address 185 (STREET, So. ETC.) Whitney (CITY) St. Hartford, Hartford, I Conn.
(COUNT
(STATE)
Probable address for the next year 185 So. Whitning St., Hourfast brun
(STREET, ETC.)
Tel ephone No. 4-5399-W.
Hartford (CITY) Hartforce (COUNTY) Loun (STATE)
Name and address of nearest relative or friend, in United States, through whom you may
be communicated with in an emergency. (State relationship)
Underline the type of work
mr. Albert W.Hitchcock. 133, How Thorne St, Hartford, Lonn-
you are now doing: - Army - Navy - U.S.P.H. Hospital - U.S.Vet. Hospital - Public
Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar. (P+b. SRetired H. hure
Are
you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? no
Have you been?
ever yes
Indicate present physical condition
good-
Would you respond to an emergency call in event of epidemic, disaster, war, etc.' ? yes.
5
Badge No. 6578
Current date mards 27-1930
J
NOTE. - - If the nurse does not complete and return this questionnaire, and can not be
&
located within two years, her enrolment will be annulled.
levet
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"ocrText": "TO\nForm 1045 Rev. 1-7-30\nNATIONAL OFFICERS\nCENTRAL COMMITTEE\nMERBERT HOOVER, PRESIDENT\nROBERT w. DE ROREST. VICE PRESIDENT\nJOHN BARTON PAYNE CHAIRMAN\nMRS. AUGUST BELMONT\nWILLIAM HOWARD TAFT, VICE PRESIDENT\nCALVIN COOLIDGE, VICE PRESIDENT\nTHE AMERICAN RED CROSS\nCORNELIUS N. BLISS\nMABEL T. BOARDMAN\nCHARLES EVANS HUGHES, JR., COUNSELOR\nJOSEPH P COTTON\nNATIONAL HEADQUARTERS\nMRS. HENRY P. DAVISON\nOGDEN L. MILLS, TREASURER\nE. B. DOUGLAS\nMABEL T. BOARDMAN. SECRETARY\nWASHINGTON, D. C.\nMRS. FRANK v. HAMMAR\nCHARLES EVANS HUGHES, JR.\nMAJ. GEN. M. w. IRELAND\nNATIONAL EXECUTIVE OFFICERS\nSAMUEL KNIGHT\nOGDEN L. MILLS\nJOHN BARTON PAYNE, CHAIRMAN\nGUSTAVUS D. POPE\nJAMES L. FIESER, VICE CHAIRMAN\nMRS, HENRY R. REA\nREAR ADMIRAL CHARLES E. RIGGS\nERNEST P. BICKNELL, VICE CHAIRMAN\nJOHN D, RYAN\nJAMES K. McCLINTOCK, VICE CHAIRMAN\nGEORGE E, SCOTT\na\nELIOT WADSWORTH\n5\nDear Madam:\nThe National Committee on Red Cross Nursing Service requires us to submit,\nannually, a list of all the Red Cross Nurses enrolled with our Committee, with their\nlatest addresses. We are extremely anxious to make a very complete report to National\nHeadquarters and ask for your cooperation. Please answer the following questions and\nreturn this form to me, in enclosed envelope, at the earliest possible date.\nIMPORTANT:\nYours sincerely,\nIn order to render prompt service\nChairman or\nin time of disaster, enrolled Red Cross\nEDNA C. MOAG\nnurses should report at once to the\nSecretary.\nSECRETARY, LOCAL COMMITTEE\nSecretary of the Local Committee under\nRED CROSS NURSING SERVICE Local Committee.\nwhich they are enrolled. Do not forget\n130 CLINTON STREET\nthe address of the-Secretary.\nBROOKLYN, N. Y,\nName in full\nJane Eligabeth Hitchcock\nIf married, give husband's name\nm-married\nPermanent address 185 (STREET, So. ETC.) Whitney (CITY) St. Hartford, Hartford, I Conn.\n(COUNT\n(STATE)\nProbable address for the next year 185 So. Whitning St., Hourfast brun\n(STREET, ETC.)\nTel ephone No. 4-5399-W.\nHartford (CITY) Hartforce (COUNTY) Loun (STATE)\nName and address of nearest relative or friend, in United States, through whom you may\nbe communicated with in an emergency. (State relationship)\nUnderline the type of work\nmr. Albert W.Hitchcock. 133, How Thorne St, Hartford, Lonn-\nyou are now doing: - Army - Navy - U.S.P.H. Hospital - U.S.Vet. Hospital - Public\nHealth - Institutional - Private Duty - Industrial - Office Nurse - Registrar. (P+b. SRetired H. hure\nAre\nyou an instructor of Red Cross classes in Home Hygiene and Care of the Sick? no\nHave you been?\never yes\nIndicate present physical condition\ngood-\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.' ? yes.\n5\nBadge No. 6578\nCurrent date mards 27-1930\nJ\nNOTE. - - If the nurse does not complete and return this questionnaire, and can not be\n&\nlocated within two years, her enrolment will be annulled.\nlevet"
}