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FORM 1045
APR
REV. 1-2-35
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. C.
APR
No
Dear Madam:
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
AVIS F. FRINK
Chairman or
in time of disaster, enrolled Red Cross
SHRINERS HOSPITAL
Secretary.
Nurses should report at once to the
SAN FRANCISCO, CALIF.
Secretary of the Local Committee under
Local Committee.
which they are enrolled. Do not forget
the address of the Secretary.
Name in full
Helen La Malle
If married, give husband's name
Permanent address
600 Stockton st
San Framics
California
(STREET, ETC.)
(CITY)
(COUNTY)
STATE)
Probable address for the next year
same
(STREET ETC.)
Telephone No. Dangla 7000
(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)
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 Splendish
Would you respond to an emergency call in event of epidemic, disaster, war, etc.?
Badge No. 43588
Current date april 18,1938
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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Document data

ID: 2661789
Core: doc
Type: document

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Document identity

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Document source extras

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    "coverageEndDate": {
        "day": 10,
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        "month": 4,
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Page context

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    "mediaId": "19f9b5a1151c4911",
    "ocrText": "FORM 1045\nAPR\nREV. 1-2-35\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\nAPR\nNo\nDear Madam:\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\nAVIS F. FRINK\nChairman or\nin time of disaster, enrolled Red Cross\nSHRINERS HOSPITAL\nSecretary.\nNurses should report at once to the\nSAN FRANCISCO, CALIF.\nSecretary of the Local Committee under\nLocal Committee.\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nName in full\nHelen La Malle\nIf married, give husband's name\nPermanent address\n600 Stockton st\nSan Framics\nCalifornia\n(STREET, ETC.)\n(CITY)\n(COUNTY)\nSTATE)\nProbable address for the next year\nsame\n(STREET ETC.)\nTelephone No. Dangla 7000\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)\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 Splendish\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.?\nBadge No. 43588\nCurrent date april 18,1938\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."
}

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