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FORM 1045-A REV. 7-9-32
NATIONAL OFFICERS
FRANKLIN D. ROOSEVELT. PRESIDENT
+
CENTRAL COMMITTEE
JOHN BARTON PAYNE, CHAIRMAN
CHARLES EVANS HUGHES, VICE PRESIDENT
ARTHUR A. BALLANTINE
HERBERT HOOVER. VICE PRESIDENT
THE AMERICAN RED CROSS
MRS. AUGUST BELMONT
CORNELIUS N. BLISS
THOMAS D. THACHER. COUNSELOR
NATIONAL HEADQUARTERS
MABEL T. BOARDMAN
ARTHUR A. BALLANTINE, TREASURER
MRS. HENRY P. DAVISON
MABEL T. BOARDMAN. SECRETARY
WASHINGTON, D. C.
WILLIAM FORTUNE
SAMUEL KNIGHT
MAJ. GEN. ROBERT U. PATTERSON
NATIONAL EXECUTIVE OFFICERS
WILLIAM PHILLIPS
GUSTAVUS D. POPE
JOHN BARTON PAYNE. CHAIRMAN
MRS. HENRY R. REA
JAN 30 1934
REAR ADMIRAL PERCEVAL s. ROSSITER
JAMES L. FIESER, VICE CHAIRMAN
GEORGE E. SCOTT
ERNEST P. BICKNELL. VICE CHAIRMAN
HENRY UPSON SIMS
JAMES K. MCCLINTOCK, VICE CHAIRMAN
ALFRED E. SMITH
THOMAS D. THACHER
ELIOT WADSWORTH
FEB 1934
Dear Madam:
using
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
very Muring esore
If married, give husband's name
Permanent address Ll. S. Public Health Service
(STREET, ETC.)
(CITY)
(COUNTY)
(STATE)
n
Probable address for the next year
w use DC
(STREET, ETC.)
Telephone No. na 5 710-
(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
good
Would you respond to an emergency call in event of epidemic, disaster, war, etc.?
Badge No. 1418
Current date
2-3-34
NOTE.-- 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-A REV. 7-9-32\nNATIONAL OFFICERS\nFRANKLIN D. ROOSEVELT. PRESIDENT\n+\nCENTRAL COMMITTEE\nJOHN BARTON PAYNE, CHAIRMAN\nCHARLES EVANS HUGHES, VICE PRESIDENT\nARTHUR A. BALLANTINE\nHERBERT HOOVER. VICE PRESIDENT\nTHE AMERICAN RED CROSS\nMRS. AUGUST BELMONT\nCORNELIUS N. BLISS\nTHOMAS D. THACHER. COUNSELOR\nNATIONAL HEADQUARTERS\nMABEL T. BOARDMAN\nARTHUR A. BALLANTINE, TREASURER\nMRS. HENRY P. DAVISON\nMABEL T. BOARDMAN. SECRETARY\nWASHINGTON, D. C.\nWILLIAM FORTUNE\nSAMUEL KNIGHT\nMAJ. GEN. ROBERT U. PATTERSON\nNATIONAL EXECUTIVE OFFICERS\nWILLIAM PHILLIPS\nGUSTAVUS D. POPE\nJOHN BARTON PAYNE. CHAIRMAN\nMRS. HENRY R. REA\nJAN 30 1934\nREAR ADMIRAL PERCEVAL s. ROSSITER\nJAMES L. FIESER, VICE CHAIRMAN\nGEORGE E. SCOTT\nERNEST P. BICKNELL. VICE CHAIRMAN\nHENRY UPSON SIMS\nJAMES K. MCCLINTOCK, VICE CHAIRMAN\nALFRED E. SMITH\nTHOMAS D. THACHER\nELIOT WADSWORTH\nFEB 1934\nDear Madam:\nusing\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\nvery Muring esore\nIf married, give husband's name\nPermanent address Ll. S. Public Health Service\n(STREET, ETC.)\n(CITY)\n(COUNTY)\n(STATE)\nn\nProbable address for the next year\nw use DC\n(STREET, ETC.)\nTelephone No. na 5 710-\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 present physical condition\ngood\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.?\nBadge No. 1418\nCurrent date\n2-3-34\nNOTE.-- the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrolment will be annulled."
}