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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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34
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0
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27b2a7429b2d77f3
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2661985
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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."
}