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FORM 1045
REV. 4-4-38
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D.C.
us
Miss Annie Earle Slack,
ye
55 South Franklin Turnpike,
Ramsey, N.J.
1940
sweet
aspi
13
Dear Red Cross Nurse:
QUESTIONNAWRES DESTROVED
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
C.M. Konrad, R. N
Secretary.
Nurses should report at once to the
88 Clifton Place,
Secretary of the Local Committee under
Jersey City,
Local Committee.
which they are enrolled. Do not forget
N.J
the address of the Secretary.
Name
in full annie Earle Stack, R. N.
If married, give husband's name
Permanent address 55 So (STREET, Feranklin ATC.) Durukike (CITY) ACOUNTY) Ramey (STATE) E.g.
Probable address the next year
for Same as above
(STREET, ETC.)
Telephone No. Ramsey 194 (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)
Surs. H.a.arnold 52 Edgewood Ave., Youkers, R.Y.
Underline the type of work you are now dding:
Army - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service -
Public Health - Institutional - Priyate Duty - Industrial - Office Nurse - Registrar
jaw looking 3 Boardersumy own home
Are you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? ho
Indicate present physical condition Excellent
Have you ever been? yes Would you like to teach Red Cross classes? yes.
Would
you respond to an emergency call in event of epidemic, disaster, war, etc.? yes.
Badge No. 5504
Current date march 8, 1940
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.
P.T.O.
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"ocrText": "for\nCurres\n+\nissop\n-\nFORM 1045\nREV. 4-4-38\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D.C.\nus\nMiss Annie Earle Slack,\nye\n55 South Franklin Turnpike,\nRamsey, N.J.\n1940\nsweet\naspi\n13\nDear Red Cross Nurse:\nQUESTIONNAWRES DESTROVED\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\nC.M. Konrad, R. N\nSecretary.\nNurses should report at once to the\n88 Clifton Place,\nSecretary of the Local Committee under\nJersey City,\nLocal Committee.\nwhich they are enrolled. Do not forget\nN.J\nthe address of the Secretary.\nName\nin full annie Earle Stack, R. N.\nIf married, give husband's name\nPermanent address 55 So (STREET, Feranklin ATC.) Durukike (CITY) ACOUNTY) Ramey (STATE) E.g.\nProbable address the next year\nfor Same as above\n(STREET, ETC.)\nTelephone No. Ramsey 194 (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)\nSurs. H.a.arnold 52 Edgewood Ave., Youkers, R.Y.\nUnderline the type of work you are now dding:\nArmy - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service -\nPublic Health - Institutional - Priyate Duty - Industrial - Office Nurse - Registrar\njaw looking 3 Boardersumy own home\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? ho\nIndicate present physical condition Excellent\nHave you ever been? yes Would you like to teach Red Cross classes? yes.\nWould\nyou respond to an emergency call in event of epidemic, disaster, war, etc.? yes.\nBadge No. 5504\nCurrent date march 8, 1940\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.\nP.T.O."
}