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FORM 1045 REV. 2-16-31
NATIONAL OFFICERS
CENTRAL COMMITTEE
HERBERT HOOVER, PRESIDENT
JOHN BARTON PAYNE, CHAIRMAN
ROBERT W. DE FOREST. VICE PRESIDENT
MRS. AUGUST BELMONT
CALVIN COOLIDGE. VICE PRESIDENT
THE AMERICAN RED CROSS
CORNELIUS N. BLISS
MABEL T. BOARDMAN
CHARLES EVANS HUGHES. VICE PRESIDENT
JOSEPH P. COTTON
THOMAS D. THACHER. COUNSELOR
NATIONAL HEADQUARTERS
MRS. HENRY P. DAVISON
MRS. FRANK V. HAMMAR
OGDEN L. MILLS. TREASURER
WASHINGTON, D.C.
MAJ. GEN. M. w. IRELAND
MABEL T. BOARDMAN. SECRETARY
SAMUEL KNIGHT
OGDEN L. MILLS
GUSTAVUS D. POPE
NATIONAL EXECUTIVE OFFICERS
MRS. HENRY R. REA
REAR ADMIRAL CHARLES E. RIGGS
JOHN BARTON PAYNE, CHAIRMAN
JOHN D. RYAN
JAMES L. FIESER. VICE CHAIRMAN
GEORGE E. SCOTT
ERNEST P. BICKNELL, VICE CHAIRMAN
HENRY UPSON SIMS
THOMAS D. THACHER
JAMES K. McCLINTOCK, VICE CHAIRMAN
ELIOT WADSWORTH
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:
In order to render prompt service
Yours sincerely,
in time of disaster, enrolled Red Cross
Mrs. Ferne G. Goodwin
Chairman or
Nurses should report at once to the
Secyrr State and Local Committee,
Secretary.
Secretary of the Local Committee under
Red Cross Nursing Service.
which they are enrolled. Do not forget
-22-SGHOOL-STREET
Local Committee.
the address of the Secretary.
RUNSWICK
MAINE
Name in full
Alyan nella Lockney
If married, give husband's
Permanent address 301 main
name James Saco Clifford factury
CITY
York
maine
STREET, ETC.
COUNTY
STATE
Probable address for the next year
same
STREET. ETC.
Telephone No Bidd 685 w
Race
your
mr
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)
husband
saes me
Underline the type of work
you are now doing: Army - Navy - U.S.P.H. Hospital U.S. Vet. Hospital - 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?
Indicate present physical condition raw
yes
Would respond emergency epidemic, disaster, war, etc.? not able
you to an call in event of
Badge No. 9769
Current date march 19 1933
NOTE.-If the nurse does not complete and return this questionnaire, and can not be
located within two years, her enrolment will be annulled.
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"ocrText": "FORM 1045 REV. 2-16-31\nNATIONAL OFFICERS\nCENTRAL COMMITTEE\nHERBERT HOOVER, PRESIDENT\nJOHN BARTON PAYNE, CHAIRMAN\nROBERT W. DE FOREST. VICE PRESIDENT\nMRS. AUGUST BELMONT\nCALVIN COOLIDGE. VICE PRESIDENT\nTHE AMERICAN RED CROSS\nCORNELIUS N. BLISS\nMABEL T. BOARDMAN\nCHARLES EVANS HUGHES. VICE PRESIDENT\nJOSEPH P. COTTON\nTHOMAS D. THACHER. COUNSELOR\nNATIONAL HEADQUARTERS\nMRS. HENRY P. DAVISON\nMRS. FRANK V. HAMMAR\nOGDEN L. MILLS. TREASURER\nWASHINGTON, D.C.\nMAJ. GEN. M. w. IRELAND\nMABEL T. BOARDMAN. SECRETARY\nSAMUEL KNIGHT\nOGDEN L. MILLS\nGUSTAVUS D. POPE\nNATIONAL EXECUTIVE OFFICERS\nMRS. HENRY R. REA\nREAR ADMIRAL CHARLES E. RIGGS\nJOHN BARTON PAYNE, CHAIRMAN\nJOHN D. RYAN\nJAMES L. FIESER. VICE CHAIRMAN\nGEORGE E. SCOTT\nERNEST P. BICKNELL, VICE CHAIRMAN\nHENRY UPSON SIMS\nTHOMAS D. THACHER\nJAMES K. McCLINTOCK, VICE CHAIRMAN\nELIOT WADSWORTH\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:\nIn order to render prompt service\nYours sincerely,\nin time of disaster, enrolled Red Cross\nMrs. Ferne G. Goodwin\nChairman or\nNurses should report at once to the\nSecyrr State and Local Committee,\nSecretary.\nSecretary of the Local Committee under\nRed Cross Nursing Service.\nwhich they are enrolled. Do not forget\n-22-SGHOOL-STREET\nLocal Committee.\nthe address of the Secretary.\nRUNSWICK\nMAINE\nName in full\nAlyan nella Lockney\nIf married, give husband's\nPermanent address 301 main\nname James Saco Clifford factury\nCITY\nYork\nmaine\nSTREET, ETC.\nCOUNTY\nSTATE\nProbable address for the next year\nsame\nSTREET. ETC.\nTelephone No Bidd 685 w\nRace\nyour\nmr\nCITY\nCOUNTY\nSTATE\nName and address of nearest relative or friend, in United States, through whom you may\nbe communicated with in an emergency. (State relationship)\nhusband\nsaes me\nUnderline the type of work\nyou are now doing: Army - Navy - U.S.P.H. Hospital U.S. Vet. Hospital - U.S. Indian\nService - Public Health - Institutional - Private Duty - Industrial - Office Nurse -\nRegistrar.\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? no\nHave you ever been?\nIndicate present physical condition raw\nyes\nWould respond emergency epidemic, disaster, war, etc.? not able\nyou to an call in event of\nBadge No. 9769\nCurrent date march 19 1933\nNOTE.-If the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrolment will be annulled."
}