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FORM 1045--REV. 2-24-27
NATIONAL OFFICERS
CENTRAL COMMITTEE
JALVIN COOLIDGE. 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
WILLIAM D. MITCHELL, COUNSELOR
MRS, HENRY P. DAVISON
CHARLES s. DEWEY, TREASURER
NATIONAL HEADQUARTERS
CHARLES s. DEWEY
MABEL T. BOARDMAN. SECRETARY
E, B. DOUGLAS
WASHINGTON. D.C.
JOSEPH c. GREW
MRS. FRANK v. HAMMAR
HERBERT HOOVER
NATIONAL EXECUTIVE OFFICERS
MAJ. GEN. M. w. IRELAND
WILLIAM D. MITCHELL
JOHN BARTON PAYNE, CHAIRMAN
w.w. MORROW
JAMES L. FIESER, VICE CHAIRMAN
GUSTAVUS D. POPE
ERNEST P BICKNELL. VICE CHAIRMAN
MRS. HENRY R. REA
JOHN D. RYAN
GEORGE E. SCOTT
REAR ADMIRAL E. R. STITT
State and Local Committes
Red Cross Nursing Service
Providence, R. la
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 the enclosed envelope, at the earliest possible date.
IMPORTANT:
Yours sincerely,
In order to render prompt service
Chairman or
in time of disaster, enrolled Red Cross
MRS. PAUL APPLETON
nurses should report at once to the
Secretary.
35 Taber Ave.
Secretary of the Local Committee under
PROVIDENCE, R.L
Local Committee.
which they are enrolled. Do not forget
the address of the Secretary.
Name in full
adu H Staffant
Permanent address 825 challestin are Prendume
If married, give husband's name
Probable address for the next year same
R.l.
Telephone No. GN1625
Name and address of nearest relative or friend, in United States, through whom you may
be communicated with in an emergency. (State relationship)
Rebecca a Stafford (sister ) 10 Barnes PN, Prendence Rd
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.
Hospital Social service.
Have you ever been?
Are you instructor in Home Hygiene and Care of the Sick? yes
an of Red Cross classes
Indicate present physical condition Gord
Would you respond to an emergency call in event of epidemic, disaster, war, etc. ?
Badge No. 29467
Current date 4-1-27
NOTE.--If the nurse does not complete and return this questionnaire, and can not be
located within two years, her enrollment will be annulled.
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"ocrText": "+\nFORM 1045--REV. 2-24-27\nNATIONAL OFFICERS\nCENTRAL COMMITTEE\nJALVIN COOLIDGE. 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\nWILLIAM D. MITCHELL, COUNSELOR\nMRS, HENRY P. DAVISON\nCHARLES s. DEWEY, TREASURER\nNATIONAL HEADQUARTERS\nCHARLES s. DEWEY\nMABEL T. BOARDMAN. SECRETARY\nE, B. DOUGLAS\nWASHINGTON. D.C.\nJOSEPH c. GREW\nMRS. FRANK v. HAMMAR\nHERBERT HOOVER\nNATIONAL EXECUTIVE OFFICERS\nMAJ. GEN. M. w. IRELAND\nWILLIAM D. MITCHELL\nJOHN BARTON PAYNE, CHAIRMAN\nw.w. MORROW\nJAMES L. FIESER, VICE CHAIRMAN\nGUSTAVUS D. POPE\nERNEST P BICKNELL. VICE CHAIRMAN\nMRS. HENRY R. REA\nJOHN D. RYAN\nGEORGE E. SCOTT\nREAR ADMIRAL E. R. STITT\nState and Local Committes\nRed Cross Nursing Service\nProvidence, R. la\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 the enclosed envelope, at the earliest possible date.\nIMPORTANT:\nYours sincerely,\nIn order to render prompt service\nChairman or\nin time of disaster, enrolled Red Cross\nMRS. PAUL APPLETON\nnurses should report at once to the\nSecretary.\n35 Taber Ave.\nSecretary of the Local Committee under\nPROVIDENCE, R.L\nLocal Committee.\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nName in full\nadu H Staffant\nPermanent address 825 challestin are Prendume\nIf married, give husband's name\nProbable address for the next year same\nR.l.\nTelephone No. GN1625\nName and address of nearest relative or friend, in United States, through whom you may\nbe communicated with in an emergency. (State relationship)\nRebecca a Stafford (sister ) 10 Barnes PN, Prendence Rd\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.\nHospital Social service.\nHave you ever been?\nAre you instructor in Home Hygiene and Care of the Sick? yes\nan of Red Cross classes\nIndicate present physical condition Gord\nWould you respond to an emergency call in event of epidemic, disaster, war, etc. ?\nBadge No. 29467\nCurrent date 4-1-27\nNOTE.--If the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrollment will be annulled."
}