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FORM 1045
REV. 4-4-38
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. c.
30 1938
NOV 61938
Dear Red Cross Nurse:
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 order to render prompt service
Yours sincerely,
in time of disaster, enrolled Red Cross
Chairman or
Clara M. Konrad,
Nurses should report at once to the
Secretary.
Secretary of the Local Committee under
which they are enrolled. Do not forget
Jersey City, N.J. Local Committee.
the address of the Secretary.
Name in full Gume Carle Slack
If married, give husband's name
Permanent address 55 So. (STREET. Frauk ETC.) Durnyuke, (CITY) Ram (COUNTY) sey, (STATE)
Probable address for the next year
same as above
Hearfessory
(STREET, ETC.)
Telephone No. Rawsey 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)
Doris a Hunter , Sister address as above
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 - Priyate Duty - Industrial - Office Nurse - Registrar.
Dave runing a boarders houce n my own arivate home
Are you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? ho.
Have you ever been? yes Would you like teach Red Cross classes?
to
Indicate present physical condition Excellent
Would to no
you respond an emergency call in event of epidemic, disaster, war, etc.
Badge No. 15,504
Current date Goverbes 30, 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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"ocrText": "FORM 1045\nREV. 4-4-38\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. c.\n30 1938\nNOV 61938\nDear Red Cross Nurse:\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 order to render prompt service\nYours sincerely,\nin time of disaster, enrolled Red Cross\nChairman or\nClara M. Konrad,\nNurses should report at once to the\nSecretary.\nSecretary of the Local Committee under\nwhich they are enrolled. Do not forget\nJersey City, N.J. Local Committee.\nthe address of the Secretary.\nName in full Gume Carle Slack\nIf married, give husband's name\nPermanent address 55 So. (STREET. Frauk ETC.) Durnyuke, (CITY) Ram (COUNTY) sey, (STATE)\nProbable address for the next year\nsame as above\nHearfessory\n(STREET, ETC.)\nTelephone No. Rawsey 194\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)\nDoris a Hunter , Sister address as above\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 - Priyate Duty - Industrial - Office Nurse - Registrar.\nDave runing a boarders houce n my own arivate home\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? ho.\nHave you ever been? yes Would you like teach Red Cross classes?\nto\nIndicate present physical condition Excellent\nWould to no\nyou respond an emergency call in event of epidemic, disaster, war, etc.\nBadge No. 15,504\nCurrent date Goverbes 30, 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."
}