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FORM 1045-A
REV. 12-3-37
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. C.
A. R. C. MAIL ROOM
RECEIVED
e
APR 8 1938
APR 1
1938
Referred To
14
B
Dear Red Cross Nurse:
OFSTROVED
-
2111 J.
The National Committee on Red Cross Nursing Service requires us to submit,
annually, a list of all enrolled Red Cross Nurses with their latest addresses. We are
transportation
S
extremely anxious to make a very complete report and ask for your cooperation. Will
you kindly answer the following questions and return this form to me, in the enclosed
e
envelope, at the earliest possible date?
Yours sincerely,
IMPORTANT:
e
In order to render prompt service
in time of disaster, enrolled Red Cross
Ida 7. Butter
Nurses should report at once to the
Secretary of the Local Committee under
National Director,
which they are enrolled. Do not forget
Red Cross Nursing Service
the address of the Secretary.
Name in full Vita Blanche markley
If married, give husband's name
Permanent address
West Paint Hancack Itlinois
(STREET, ETC.)
(CITY)
(COUNTY)
(STATE)
Probable address for the next year
u- Vitearo (STREET, Hospital ETC.)
Telephone No.
Knoxille manum Iowa
(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)
mo Lama E markley (mother) West Paint, Illinois
Underline the type of work you are now doing:
Army - Navy - J.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? no
Indicate present physical condition Excellent
Would you respond to emergency call in of epidemic, disaster, war, etc. ? yes
an event
Badge No. 17177
Current date april 6th 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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"ocrText": "M\nar\nK\n-\n(b\nFORM 1045-A\nREV. 12-3-37\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\nA. R. C. MAIL ROOM\nRECEIVED\ne\nAPR 8 1938\nAPR 1\n1938\nReferred To\n14\nB\nDear Red Cross Nurse:\nOFSTROVED\n-\n2111 J.\nThe National Committee on Red Cross Nursing Service requires us to submit,\nannually, a list of all enrolled Red Cross Nurses with their latest addresses. We are\ntransportation\nS\nextremely anxious to make a very complete report and ask for your cooperation. Will\nyou kindly answer the following questions and return this form to me, in the enclosed\ne\nenvelope, at the earliest possible date?\nYours sincerely,\nIMPORTANT:\ne\nIn order to render prompt service\nin time of disaster, enrolled Red Cross\nIda 7. Butter\nNurses should report at once to the\nSecretary of the Local Committee under\nNational Director,\nwhich they are enrolled. Do not forget\nRed Cross Nursing Service\nthe address of the Secretary.\nName in full Vita Blanche markley\nIf married, give husband's name\nPermanent address\nWest Paint Hancack Itlinois\n(STREET, ETC.)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address for the next year\nu- Vitearo (STREET, Hospital ETC.)\nTelephone No.\nKnoxille manum Iowa\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)\nmo Lama E markley (mother) West Paint, Illinois\nUnderline the type of work you are now doing:\nArmy - Navy - J.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? no\nIndicate present physical condition Excellent\nWould you respond to emergency call in of epidemic, disaster, war, etc. ? yes\nan event\nBadge No. 17177\nCurrent date april 6th 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."
}