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FORM 1045
REV. 4-4-38
E
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
a
WASHINGTON, D.C.
+
5
12 QUESTIONNAIRES DESTROYED
L
/
great ennaise
0
Dear Red Cross Nurse
a
e
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
Chairman or
in time of disaster, enrolled Red Cross
NELLIE, A BROWN
Secretary.
Nurses should report at once to the
Madison General Hocpital
Secretary of the Local Committee under
MADISON, WISCONSIN Local Committee.
which they are enrolled. Do not forget
the address of the Secretary.
Name in full Mitith h Olson
-
If married, give husband's name
madison
wis
Permanent address
(STREET, ETC.)
(CITY)
(COUNTY)
(STATE)
Probable until address Sept for the 1940 next only year 509 Beacon Sr.&8
(STREET, ETC.)
Telephone No. ma 8177
minneapolis Hemejani (COUNTY)
mism
(CITY)
(STATE)
Ext. 284
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:
ms Family Reed, (aunt) Cokato, minisota
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? no
Have you ever been? no Would you like to teach Red Cross classes? not now
3
Indicate present physical condition good
Would you respond to an emergency call in event of epidemic, disaster, war, etc. ? yes
of
Badge No. 38755
Current date 3/2/40
9
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": "0\nFORM 1045\nREV. 4-4-38\nE\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\na\nWASHINGTON, D.C.\n+\n5\n12 QUESTIONNAIRES DESTROYED\nL\n/\ngreat ennaise\n0\nDear Red Cross Nurse\na\ne\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\nChairman or\nin time of disaster, enrolled Red Cross\nNELLIE, A BROWN\nSecretary.\nNurses should report at once to the\nMadison General Hocpital\nSecretary of the Local Committee under\nMADISON, WISCONSIN Local Committee.\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nName in full Mitith h Olson\n-\nIf married, give husband's name\nmadison\nwis\nPermanent address\n(STREET, ETC.)\n(CITY)\n(COUNTY)\n(STATE)\nProbable until address Sept for the 1940 next only year 509 Beacon Sr.&8\n(STREET, ETC.)\nTelephone No. ma 8177\nminneapolis Hemejani (COUNTY)\nmism\n(CITY)\n(STATE)\nExt. 284\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:\nms Family Reed, (aunt) Cokato, minisota\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? no\nHave you ever been? no Would you like to teach Red Cross classes? not now\n3\nIndicate present physical condition good\nWould you respond to an emergency call in event of epidemic, disaster, war, etc. ? yes\nof\nBadge No. 38755\nCurrent date 3/2/40\n9\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."
}