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FORM 1045
REV. 1-2-35
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. C.
RECEIVED
JAN 19 1937
December 28, 1936
Bureau of Public Health
REFER TO
Dear Madam:
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-
ognize the value of filing this information and will return the questionnaire promptly,
as we are extremely anxious to make a very complete report to National Headquarters.
IMPORTANT:
Yours sincerely,
In order to render prompt service
or
in time of disaster, enrolled Red Cross
Nurses should report at once to the
mary Secretary. Chairman
Secretary of the Local Committee under
State x
Local Committee.
which they are enrolled. Do not forget
the address of the Secretary.
Name in full
the happen U. Druggan
If married, give husband's name
Permanent address
Toxy-
Placitas Sauderal n.mus
(STREET, ETC.
(CITY)
(COUNTY)
(STATE)
Probable address for the next year
n
if
11
(STREET, ETC.)
Telephone No.
(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)
llmir wuggaw- sister - 1819 W.Pinkhing Bonl, Chicag 0
Underline the type of work you are now doing:
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?
not waking as present
Have you ever been?
No
Indicate present physical condition very good
Would you respond to an emergency call in event of epidemic, disaster, war, etc. ? uas
Badge No. 712373
Current
date Jan 17,1937
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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Document data
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"ocrText": "FORM 1045\nREV. 1-2-35\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\nRECEIVED\nJAN 19 1937\nDecember 28, 1936\nBureau of Public Health\nREFER TO\nDear Madam:\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-\nognize the value of filing this information and will return the questionnaire promptly,\nas we are extremely anxious to make a very complete report to National Headquarters.\nIMPORTANT:\nYours sincerely,\nIn order to render prompt service\nor\nin time of disaster, enrolled Red Cross\nNurses should report at once to the\nmary Secretary. Chairman\nSecretary of the Local Committee under\nState x\nLocal Committee.\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nName in full\nthe happen U. Druggan\nIf married, give husband's name\nPermanent address\nToxy-\nPlacitas Sauderal n.mus\n(STREET, ETC.\n(CITY)\n(COUNTY)\n(STATE)\nProbable address for the next year\nn\nif\n11\n(STREET, ETC.)\nTelephone No.\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)\nllmir wuggaw- sister - 1819 W.Pinkhing Bonl, Chicag 0\nUnderline the type of work you are now doing:\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?\nnot waking as present\nHave you ever been?\nNo\nIndicate present physical condition very good\nWould you respond to an emergency call in event of epidemic, disaster, war, etc. ? uas\nBadge No. 712373\nCurrent\ndate Jan 17,1937\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."
}