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Form 1045 Rev. 1-7-30
NATIONAL OFFICERS
CENTRAL COMMITTEE
HERBERT HOOVER. PRESIDENT
JOHN BARTON PAYNE. CHAIRMAN
ROBERT W. DE FOREST. VICE PRESIDENT
MRS. AUGUST BELMONT
WILLIAM HOWARD TAFT. VICE PRESIDENT
THE AMERICAN RED CROSS
CORNELIUS N. BLISS
MABEL T. BOARDMAN
CALVIN COOLIDGE, VICE PRESIDENT
JOSEPH P. COTTON
CHARLES EVANS HUGHES. JR.. COUNSELOR
NATIONAL HEADQUARTERS
MRS. HENRY P. DAVISON
OGDEN L. MILLS. TREASURER
E. B. DOUGLAS
WASHINGTON, D. C.
MRS. FRANK v. HAMMAR
MABEL T. BOARDMAN. SECRETARY
CHARLES EVANS HUGHES, JR.
MAJ. GEN. M. W. IRELAND
SAMUEL KNIGHT
NATIONAL EXECUTIVE OFFICERS
OGDEN L. MILLS
GUSTAVUS D. POPE
JOHN BARTON PAYNE. CHAIRMAN
MRS. HENRY R. REA
JAMES L. FIESER, VICE CHAIRMAN
REAR ADMIRAL CHARLES E. RIGGS
ERNEST P. BICKNELL. VICE CHAIRMAN
JOHN D. RYAN
GEORGE E. SCOTT
JAMES K. MCCLINTOCK. VICE CHAIRMAN
ELIOT WADSWORTH
Dear Madam:
The National Committee on Red Cross Nursing Service requires us to submit,
annually, a list of all the Red Cross Nurses enrolled with our Committee, with their
latest addresses. We are extremely anxious to make a very complete report to National
Headquarters and ask for your cooperation. Please answer the following questions and
return this form to me, in enclosed envelope, at the earliest possible date.
IMPORTANT:
Yours sincerely,
In order to render prompt service
Chairman or
ELLA E. McNEIL, R. N.
in time of disaster, enrolled Red Cross
2100 DELANCEY STREET
Secretary.
nurses should report at once to the
Secretary of the Local Committee under
PHILADELPHIA, PENNA.
Local Committee.
which they are enrolled. Do not forget
the address of the Secretary.
Name in full
Juliet sayder
If married, give husband's name
Permanent address HAVO
Pa
(STREET, ETC.)
(CITY)
(COUNTY)
(STATE)
Probable address for the next year
Same
(STREET, ETC.)
Tel ephone No. Bav-2566
(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: - Army - Navy - U.S.P.H. Hospital - U.S.Vet. Hospital - 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?
Have you ever been?
no
Indicate present physical condition
Hair -
Would you respond to an emergency call in event of epidemic, disaster, war, etc.?
yes
Badge No. 23904
Current date
March 71st-1930
NOTE.--I: the nurse does not complete and return this questionnaire, and can not be
located within two years, her enrolment will be annulled.
Page data
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Document data
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- Core
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"ocrText": "Form 1045 Rev. 1-7-30\nNATIONAL OFFICERS\nCENTRAL COMMITTEE\nHERBERT HOOVER. PRESIDENT\nJOHN BARTON PAYNE. CHAIRMAN\nROBERT W. DE FOREST. VICE PRESIDENT\nMRS. AUGUST BELMONT\nWILLIAM HOWARD TAFT. VICE PRESIDENT\nTHE AMERICAN RED CROSS\nCORNELIUS N. BLISS\nMABEL T. BOARDMAN\nCALVIN COOLIDGE, VICE PRESIDENT\nJOSEPH P. COTTON\nCHARLES EVANS HUGHES. JR.. COUNSELOR\nNATIONAL HEADQUARTERS\nMRS. HENRY P. DAVISON\nOGDEN L. MILLS. TREASURER\nE. B. DOUGLAS\nWASHINGTON, D. C.\nMRS. FRANK v. HAMMAR\nMABEL T. BOARDMAN. SECRETARY\nCHARLES EVANS HUGHES, JR.\nMAJ. GEN. M. W. IRELAND\nSAMUEL KNIGHT\nNATIONAL EXECUTIVE OFFICERS\nOGDEN L. MILLS\nGUSTAVUS D. POPE\nJOHN BARTON PAYNE. CHAIRMAN\nMRS. HENRY R. REA\nJAMES L. FIESER, VICE CHAIRMAN\nREAR ADMIRAL CHARLES E. RIGGS\nERNEST P. BICKNELL. VICE CHAIRMAN\nJOHN D. RYAN\nGEORGE E. SCOTT\nJAMES K. MCCLINTOCK. VICE CHAIRMAN\nELIOT WADSWORTH\nDear Madam:\nThe National Committee on Red Cross Nursing Service requires us to submit,\nannually, a list of all the Red Cross Nurses enrolled with our Committee, with their\nlatest addresses. We are extremely anxious to make a very complete report to National\nHeadquarters and ask for your cooperation. Please answer the following questions and\nreturn this form to me, in enclosed envelope, at the earliest possible date.\nIMPORTANT:\nYours sincerely,\nIn order to render prompt service\nChairman or\nELLA E. McNEIL, R. N.\nin time of disaster, enrolled Red Cross\n2100 DELANCEY STREET\nSecretary.\nnurses should report at once to the\nSecretary of the Local Committee under\nPHILADELPHIA, PENNA.\nLocal Committee.\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nName in full\nJuliet sayder\nIf married, give husband's name\nPermanent address HAVO\nPa\n(STREET, ETC.)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address for the next year\nSame\n(STREET, ETC.)\nTel ephone No. Bav-2566\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\nyou are now doing: - Army - Navy - U.S.P.H. Hospital - U.S.Vet. Hospital - Public\nHealth - Institutional - Private Duty - Industrial - Office Nurse - Registrar.\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick?\nHave you ever been?\nno\nIndicate present physical condition\nHair -\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.?\nyes\nBadge No. 23904\nCurrent date\nMarch 71st-1930\nNOTE.--I: the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrolment will be annulled."
}