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FORM 1045
REV. 12-3-37
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. C.
12
MAR 15 1938
QUESTION state DESTROYED
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,
Chairman or
in time of disaster, enrolled Red Cross
MARION A. BACKUS, R. N.
Secretary.
Nurses should report at once to the
414 SOUTH 8TH ST.
Secretary of the Local Committee under
MINNEAPOLIS, MINN.
Local Committee.
which they are enrolled. Do not forget
the address of the Secretary.
Name
in full Sena m. Tippen
If married, give husband's name
Gustav I Tippen
Permanent address
Buldwice
Ar. Croix
Wisconsin
(STREET, ETC.)
(CITY)
(COUNTY)
(STATE)
Probable address for the next year
16
"
++
(STREET, ETC.)
Telephone No. none
(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. 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?
Have you ever been?
no
Indicate present physical condition fair
Would you respond to an emergency call in event of epidemic, disaster, war, etc. ? no
Badge No. 4823
Current date 1-31-38
over
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.
(over)
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- Core
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"ocrText": "FORM 1045\nREV. 12-3-37\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\n12\nMAR 15 1938\nQUESTION state DESTROYED\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,\nChairman or\nin time of disaster, enrolled Red Cross\nMARION A. BACKUS, R. N.\nSecretary.\nNurses should report at once to the\n414 SOUTH 8TH ST.\nSecretary of the Local Committee under\nMINNEAPOLIS, MINN.\nLocal Committee.\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nName\nin full Sena m. Tippen\nIf married, give husband's name\nGustav I Tippen\nPermanent address\nBuldwice\nAr. Croix\nWisconsin\n(STREET, ETC.)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address for the next year\n16\n\"\n++\n(STREET, ETC.)\nTelephone No. none\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 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?\nHave you ever been?\nno\nIndicate present physical condition fair\nWould you respond to an emergency call in event of epidemic, disaster, war, etc. ? no\nBadge No. 4823\nCurrent date 1-31-38\nover\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.\n(over)"
}