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FORM 1045
REV. 1-2-35
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. C.
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:
in time of disaster, enrolled Red Cross
Gaezy Blume Care Secretary, Chairman
Yours sincerely,
In order to render prompt service
or
Nurses should report at once to the
Secretary of the Local Committee under
Wyo State t
Local Committee.
which they are enrolled. Do not forget
the address of the Secretary.
Name in full
Valeria Ritterhouse R.n.
If married, give husband's name
Permanent address % S.H. Putterhouse , Unilandistration Untario, Canada
(STREET, ETC.)
(CITY)
(COUNTY)
(STATE)
Probable address for the next year University (STREET, ETC.) Laramine
of Hyoming
Telephone No. 21 31
Laramie albany (COUNTY)
(CITY)
16 youring
(STATE)
Name and address of nearest relative or friend, in United States, through whom you may
be communicated with in an emergency. (State relationship)
Chas. J. Pittenhouse (Cousin) 4901 Woodlawn Ave. Chicago see
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? no
Have you ever been? no
Indicate Good
present physical condition
Would you respond to an emergency call in event of epidemic, disaster, war, etc.? yes
Badge No. 10664
Current date april 1-1938
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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Context sent to Scholar
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"ocrText": "FORM 1045\nREV. 1-2-35\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\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:\nin time of disaster, enrolled Red Cross\nGaezy Blume Care Secretary, Chairman\nYours sincerely,\nIn order to render prompt service\nor\nNurses should report at once to the\nSecretary of the Local Committee under\nWyo State t\nLocal Committee.\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nName in full\nValeria Ritterhouse R.n.\nIf married, give husband's name\nPermanent address % S.H. Putterhouse , Unilandistration Untario, Canada\n(STREET, ETC.)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address for the next year University (STREET, ETC.) Laramine\nof Hyoming\nTelephone No. 21 31\nLaramie albany (COUNTY)\n(CITY)\n16 youring\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)\nChas. J. Pittenhouse (Cousin) 4901 Woodlawn Ave. Chicago see\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? no\nHave you ever been? no\nIndicate Good\npresent physical condition\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.? yes\nBadge No. 10664\nCurrent date april 1-1938\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."
}