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I e.e. Sec Res V RED CROSS BADGE NUMBER AMERICAN RED CROSS 19854 L . NURSING SERVICES MILITARY SERIAL NUMBER M ANNUAL QUESTIONNAIRE - 1945 CHECK IF YOUR LAST NAME HAS CHANGED TELEPHONE NO. NAME (Last, first, middle) S. PLASS Lillian Rose IF MARRIED, GIVE MAIDEN NAME HUSBAND'S NAME Genrich Everett V. PERMANENT ADDRESS (Street, city, zone, county, state) 343 Hutchinson are Iowa City, Iowa, - PRESENT ADDRESS (Street, city, zone, county, state) NAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES RELATIONSHIP Mr. E. day, Plass Husband DATE OF BIRTH (Month, Separated W1 Ldowed Divorced feen in October 10th 1888 Single Married YES NO WHAT LANGUAGES DO YQU SPEAK? Spanish, German HIGH SCHOOL GRADUATE X NAME OF COLLEGE OR DEGREE OR ? R. UNIVERSITY ATTENDED LOCATION INCLUSIVE DATES DIPLOMA x MAJOR Babpit missionary School. Chicago gel 1910-12 an YES NO REGISTERED IN (State) ARE YOU CURRENTLY A MEMBER OF THE AMERICAN YES NO ARE YOU CURRENTLY X NURSES' ASSOCIATION? X REGISTERED? PRESENT EMPLOYMENT If not employed, check POSITION TITLE (H.N., P.D., inst., staff nurse, etc.) SERVICE (Medicine, surgery, etc.) NAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED CITY STATE HEALTH IF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY VOLUNTEER SERVICE The purpose of the following statements is to identify the nurses twho can be counted upon to respond to a call to participate in a Red Cross chapter program. Please check the "Yes" box only if you are willing and able to serve if called on within the next 12 months. NAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS 1. Teach home YES NO Attend an instructors' training program, 1f offered. (Funds are available for YES NO nursing classes training home nursing instructors. See local chapter.) X YES only in home community Attend disaster institutes, if YES NO 2. Serve in case NO of disaster In other communities offered, in preparation for service X 5. Assist with other chapter YES NO 3. Teach nurse's YES NO 4. Accept membership on chapter com- YES NO aide classes mittee should services be needed programs, as needed If you have not answered "Yes" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that YES NO you will be able to serve at some time in the future? IF UNABLE TO SERVE, GIVE MAJOR REASONS. DATE my family demands SIGNATURE all my attention augi A/RED 20 1945 Lillian R. Plass YOUR VALUE AS CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR FAITHPOLNESS KEEPING US INFORMAD OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY COMMITTEE NAMED BELOW. ATTENTION Fill in committee name and address before sending questionnaire to nurse. topic TO TKE SECRETARY BERTHA JOHNSON, Secretary NURSE RECRUITMENT RECRUITMENT COM. LINN co. CHAPTER 8 COMMITTEE 1817 "C" Ave. N.E., Cedar Rapids, lowa FORM 1045 Rev. July 1945 5 78504M x

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    "ocrText": "I\ne.e.\nSec Res V\nRED CROSS BADGE NUMBER\nAMERICAN RED CROSS\n19854\nL .\nNURSING SERVICES\nMILITARY SERIAL NUMBER\nM\nANNUAL QUESTIONNAIRE - 1945\nCHECK IF YOUR LAST NAME HAS CHANGED\nTELEPHONE NO.\nNAME (Last, first, middle)\nS.\nPLASS Lillian Rose\nIF MARRIED, GIVE MAIDEN NAME\nHUSBAND'S NAME\nGenrich\nEverett V.\nPERMANENT ADDRESS (Street, city, zone, county, state)\n343 Hutchinson are Iowa City, Iowa,\n-\nPRESENT ADDRESS (Street, city, zone, county, state)\nNAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES\nRELATIONSHIP\nMr. E. day, Plass\nHusband\nDATE OF BIRTH (Month,\nSeparated\nW1 Ldowed\nDivorced\nfeen\nin\nOctober 10th 1888\nSingle\nMarried\nYES\nNO\nWHAT LANGUAGES DO YQU SPEAK?\nSpanish, German\nHIGH SCHOOL GRADUATE\nX\nNAME OF COLLEGE OR\nDEGREE OR\n?\nR.\nUNIVERSITY ATTENDED\nLOCATION\nINCLUSIVE DATES\nDIPLOMA\nx\nMAJOR\nBabpit missionary School. Chicago gel 1910-12\nan\nYES\nNO\nREGISTERED IN (State)\nARE YOU CURRENTLY A MEMBER OF THE AMERICAN\nYES\nNO\nARE YOU CURRENTLY\nX\nNURSES' ASSOCIATION?\nX\nREGISTERED?\nPRESENT EMPLOYMENT If not employed, check\nPOSITION TITLE (H.N., P.D., inst., staff nurse, etc.)\nSERVICE (Medicine, surgery, etc.)\nNAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED\nCITY\nSTATE\nHEALTH\nIF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY\nVOLUNTEER SERVICE\nThe purpose of the following statements is to identify the nurses twho can be counted upon to respond to a call\nto participate in a Red Cross chapter program. Please check the \"Yes\" box only if you are willing and able to\nserve if called on within the next 12 months.\nNAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS\n1. Teach home\nYES\nNO\nAttend an instructors' training program, 1f offered. (Funds are available for\nYES\nNO\nnursing classes\ntraining home nursing instructors. See local chapter.)\nX\nYES\nonly in home community\nAttend disaster institutes, if\nYES\nNO\n2. Serve in case\nNO\nof disaster\nIn other communities\noffered, in preparation for service\nX\n5. Assist with other chapter\nYES\nNO\n3. Teach nurse's\nYES\nNO\n4. Accept membership on chapter com-\nYES\nNO\naide classes\nmittee should services be needed\nprograms, as needed\nIf you have not answered \"Yes\" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that\nYES\nNO\nyou will be able to serve at some time in the future?\nIF UNABLE TO SERVE, GIVE MAJOR REASONS.\nDATE my family demands SIGNATURE all my attention\naugi A/RED 20 1945\nLillian R. Plass\nYOUR VALUE AS CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR FAITHPOLNESS\nKEEPING US INFORMAD OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY\nCOMMITTEE NAMED BELOW.\nATTENTION\nFill in committee name and address before sending questionnaire to nurse.\ntopic TO TKE\nSECRETARY\nBERTHA JOHNSON, Secretary\nNURSE RECRUITMENT\nRECRUITMENT COM. LINN co. CHAPTER\n8\nCOMMITTEE\n1817 \"C\" Ave. N.E., Cedar Rapids, lowa\nFORM 1045 Rev. July 1945\n5\n78504M\nx"
}