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FORM 1045
REV. 4-4-38
is,
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
L
WASHINGTON, D.C.
E
=
17 QUESTIONNAIRES DESTROYED
APRI 1939
Dear Red Cross Nurse:
+ 3 11 y
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-
3
ognize the value of filing this information and will return the questionnaire promptly,
T
as we are extremely anxious to make a very complete report to National Headquarters.
IMPORTANT:
S
In order to render prompt service
Yours sincerely,
in time of disaster, enrolled Red Cross
Chairman or
EDNA C. HOAG
Nurses should report at once to the
Secretary.
SECRETARY; LOCAL COMMITTEI
Secretary of the Local Committee under
RED CROSS NURSING SERVICE
which they are enrolled. Do not forget
Local Committee.
60COURT ST
the address of the Secretary.
BROOKLYN, N. Y,
martin
Name in full
martin
If married, give husband's name
Permanent address
(STREET, ETC.)
Jillar
6701
(CITY) Colornial (COUNTY) Road
19.g
(STATE)
Probable address for the next year
Beg-1328
(STREET, ETC.)
Telephone No.
(CITY)
Brintelyn
(COUNTY) (STATE) ny
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 Brother type of work you John are now doing: Jeges gilton n.4
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?
Have
Indicate you present ever been? physical yes condition Would Have you like hen to teach adresed Red Cross classes? to take a rest.
w
3
Would you respond to an emergency call in event of epidemic, disaster, war, etc.?
would try
3
Badge
No. 33385
Current date
4.18.39
8
NOTE. -If the nurse does not complete and return this questionnaire, and can not be
5
located within two years, her enrolment will be removed from our active files.
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"ocrText": "N\nM\nea\na\nT\n+\nFORM 1045\nREV. 4-4-38\nis,\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nL\nWASHINGTON, D.C.\nE\n=\n17 QUESTIONNAIRES DESTROYED\nAPRI 1939\nDear Red Cross Nurse:\n+ 3 11 y\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-\n3\nognize the value of filing this information and will return the questionnaire promptly,\nT\nas we are extremely anxious to make a very complete report to National Headquarters.\nIMPORTANT:\nS\nIn order to render prompt service\nYours sincerely,\nin time of disaster, enrolled Red Cross\nChairman or\nEDNA C. HOAG\nNurses should report at once to the\nSecretary.\nSECRETARY; LOCAL COMMITTEI\nSecretary of the Local Committee under\nRED CROSS NURSING SERVICE\nwhich they are enrolled. Do not forget\nLocal Committee.\n60COURT ST\nthe address of the Secretary.\nBROOKLYN, N. Y,\nmartin\nName in full\nmartin\nIf married, give husband's name\nPermanent address\n(STREET, ETC.)\nJillar\n6701\n(CITY) Colornial (COUNTY) Road\n19.g\n(STATE)\nProbable address for the next year\nBeg-1328\n(STREET, ETC.)\nTelephone No.\n(CITY)\nBrintelyn\n(COUNTY) (STATE) ny\nName and address of nearest relative or friend, in United States, through whom you may\nbe communicated with in an emergency. (State/relationship)\nUnderline\nthe Brother type of work you John are now doing: Jeges gilton n.4\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?\nHave\nIndicate you present ever been? physical yes condition Would Have you like hen to teach adresed Red Cross classes? to take a rest.\nw\n3\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.?\nwould try\n3\nBadge\nNo. 33385\nCurrent date\n4.18.39\n8\nNOTE. -If the nurse does not complete and return this questionnaire, and can not be\n5\nlocated within two years, her enrolment will be removed from our active files."
}