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FORM 1045-A REV. 7.9.32
NATIONAL OFFICERS
+
CENTRAL COMMITTEE
FRANKLIN D. ROOSEVELT, PRESIDENT
JOHN BARTON PAYNE, CHAIRMAN
CHARLES EVANS HUGHES, VICE PRESIDENT
DEAN G. ACHESON
HERBERT HOOVER. VICE PRESIDENT
THE AMERICAN RED CROSS
MRS. AUGUST BELMONT
JAMES CRAWFORD BIGGS
JAMES CRAWFORD BIGGS. COUNSELOR
CORNELIUS N. BLISS
DEAN G. ACHESON, TREASURER
NATIONAL HEADQUARTERS
MABEL
MABEL T. BOARDMAN, SECRETARY
MRS. HENRY P. DAVISON
WASHINGTON, D. C.
WILLIAM FORTUNE
SAMUEL KNIGHT
NATIONAL EXECUTIVE OFFICERS
MAJ. GEN. ROBERT U. PATTERSON
WILLIAM PHILLIPS
JOHN BARTON PAYNE. CHAIRMAN
GUSTAVUS D. POPE
JAMES L. FIESER, VICE CHAIRMAN
MRS. HENRY R. REA
REAR ADMIRAL PERCEVAL S. ROSSITER
ERNEST P. BICKNELL. VICE CHAIRMAN
JAMES K. McCLINTOCK, VICE CHAIRMAN
FEB 9 1935
GEORGE E. SCOTT
HENRY UPSON SIMS
ALFRED E. SMITH
ELIOT WADSWORTH
F813 1935
Dear Madam:
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
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
envelope, at the earliest possible date?
Yours sincerely,
IMPORTANT:
In order to render prompt service
Clasa D.noyes
in time of disaster, enrolled Red Cross
Nurses should report at once to the
National Director,
Secretary of the Local Committee under
Red Cross Nursing Service
which they are enrolled. Do not forget
the address of the Secretary.
Name in full
Lucy
If married, give husband's name
Permanent address R.F.D.#3 Wexwedrea
ye
(STREET, ETC.)
(CITY)
(COUNTY)
(STATE)
Probable address for the next year
Same
(STREET, ETC.)
Telephone No. na 5710 B3321
Wash.
( of ancial)
(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 - U.S. Vet. 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 you ever been?
no
Indicate
present physical condition Parg
Would you respond to an emergency call in event of epidemic, etc.?
disaster, war, y
Badge No. 14.8
Current date
2-11-35
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.
Page data
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Document data
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- Core
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- Type
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"ocrText": "FORM 1045-A REV. 7.9.32\nNATIONAL OFFICERS\n+\nCENTRAL COMMITTEE\nFRANKLIN D. ROOSEVELT, PRESIDENT\nJOHN BARTON PAYNE, CHAIRMAN\nCHARLES EVANS HUGHES, VICE PRESIDENT\nDEAN G. ACHESON\nHERBERT HOOVER. VICE PRESIDENT\nTHE AMERICAN RED CROSS\nMRS. AUGUST BELMONT\nJAMES CRAWFORD BIGGS\nJAMES CRAWFORD BIGGS. COUNSELOR\nCORNELIUS N. BLISS\nDEAN G. ACHESON, TREASURER\nNATIONAL HEADQUARTERS\nMABEL\nMABEL T. BOARDMAN, SECRETARY\nMRS. HENRY P. DAVISON\nWASHINGTON, D. C.\nWILLIAM FORTUNE\nSAMUEL KNIGHT\nNATIONAL EXECUTIVE OFFICERS\nMAJ. GEN. ROBERT U. PATTERSON\nWILLIAM PHILLIPS\nJOHN BARTON PAYNE. CHAIRMAN\nGUSTAVUS D. POPE\nJAMES L. FIESER, VICE CHAIRMAN\nMRS. HENRY R. REA\nREAR ADMIRAL PERCEVAL S. ROSSITER\nERNEST P. BICKNELL. VICE CHAIRMAN\nJAMES K. McCLINTOCK, VICE CHAIRMAN\nFEB 9 1935\nGEORGE E. SCOTT\nHENRY UPSON SIMS\nALFRED E. SMITH\nELIOT WADSWORTH\nF813 1935\nDear Madam:\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\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\nenvelope, at the earliest possible date?\nYours sincerely,\nIMPORTANT:\nIn order to render prompt service\nClasa D.noyes\nin time of disaster, enrolled Red Cross\nNurses should report at once to the\nNational Director,\nSecretary of the Local Committee under\nRed Cross Nursing Service\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nName in full\nLucy\nIf married, give husband's name\nPermanent address R.F.D.#3 Wexwedrea\nye\n(STREET, ETC.)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address for the next year\nSame\n(STREET, ETC.)\nTelephone No. na 5710 B3321\nWash.\n( of ancial)\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 - U.S. Vet. 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 you ever been?\nno\nIndicate\npresent physical condition Parg\nWould you respond to an emergency call in event of epidemic, etc.?\ndisaster, war, y\nBadge No. 14.8\nCurrent date\n2-11-35\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."
}