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FORM 1045
REV. 12-3-37
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. C.
D
5
12
5
BESTROYED
0
Dear Red Cross Nurse:
a
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
is
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:
In order to render prompt service
Yours sincerely,
in time of disaster, enrolled Red Cross
AVIS F. FRINK
Chairman or
Nurses should report at once to the
Secretary.
Secretary of the Local Committee under
SAN FRANCISCO, CALIF.
which they are enrolled. Do not forget
Local Committee.
the address of the Secretary.
Name in full o'malley, anne Louis
If married, give husband's name - Single
Permanent address 746 geary Saul (CITY) -rancisco (COUNTY) S.F California TATE)
(STREET, ETC.)
Probable address for the next year
Isame as above
(STREET, ETC.)
Telephone No. Prospect 5016
(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:
malley (states) 746 geary start, Santrancisco
Army - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service -
(cleir mann Health: - office, au - 1- rancisco - - el 0480
Public Institutional Privata Duty Industrial office Murse - Registrar.
Are you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? no.
Have you ever been? ho
Indicate present physical condition Excellent
Would you respond to an emergency call in event of epidemic, disaster, war, etc.? you
63
of
Badge No. 17,586
Current date April 4.1928
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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"ocrText": "0\nM\nFORM 1045\nREV. 12-3-37\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\nD\n5\n12\n5\nBESTROYED\n0\nDear Red Cross Nurse:\na\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\nis\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:\nIn order to render prompt service\nYours sincerely,\nin time of disaster, enrolled Red Cross\nAVIS F. FRINK\nChairman or\nNurses should report at once to the\nSecretary.\nSecretary of the Local Committee under\nSAN FRANCISCO, CALIF.\nwhich they are enrolled. Do not forget\nLocal Committee.\nthe address of the Secretary.\nName in full o'malley, anne Louis\nIf married, give husband's name - Single\nPermanent address 746 geary Saul (CITY) -rancisco (COUNTY) S.F California TATE)\n(STREET, ETC.)\nProbable address for the next year\nIsame as above\n(STREET, ETC.)\nTelephone No. Prospect 5016\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:\nmalley (states) 746 geary start, Santrancisco\nArmy - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service -\n(cleir mann Health: - office, au - 1- rancisco - - el 0480\nPublic Institutional Privata Duty Industrial office Murse - Registrar.\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? no.\nHave you ever been? ho\nIndicate present physical condition Excellent\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.? you\n63\nof\nBadge No. 17,586\nCurrent date April 4.1928\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."
}