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Form 1045 Rev. 1-7-30
NATIONAL OFFICERS
HERBERT HOOVER. PRESIDENT
REC'D SEP 11 1931
CENTRAL COMMITTEE
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
E. B. DOUGLAS
OGDEN L. MILLS. TREASURER
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
JOHN D. RYAN
ERNEST P. BICKNELL. VICE CHAIRMAN
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
many I.Hall R.N,
Chairman
in time of disaster, enrolled Red Cross
Secretary.
nurses should report at once to the
Secretary of the Local Committee under
Alameda Co,
Local Committee.
which they are enrolled.
the address of the Secretary
Name in full
Do not forget mainor 6101 Donegater Place Ceak, Caly,
If married, give husband's name
Permanent address 2508 (STREET, ashbyour ETC.) Berkelly (CITY) alameda (COUNTY) Dated \(STATE)
Probable address for the next year
Tel ephone No. Thom 0094
25-08 (STREET, ETC.) Ave Burbetting
ashthy
(CITY)
(COUNTY)
(STATE)
Name and address of nearest relative or friend, in United States, through whom you may
communicated with in an emergency. State relationship)
Underline be Mrs the CM. would Cherokee Olela - (sinter)
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? no
Have you ever been?
yes
Indicate present physical condition
Convelectent.
Would you respond to an emergency call in event of epidemic, disaster, war, etc.?
Badge No. 15337
Current date
1931
NOTE. If the nurse does not complete and return this questionnaire, and can not be
located within two years, her enrolment will be annulled.
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"ocrText": "Form 1045 Rev. 1-7-30\nNATIONAL OFFICERS\nHERBERT HOOVER. PRESIDENT\nREC'D SEP 11 1931\nCENTRAL COMMITTEE\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\nE. B. DOUGLAS\nOGDEN L. MILLS. TREASURER\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\nJOHN D. RYAN\nERNEST P. BICKNELL. VICE CHAIRMAN\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\nmany I.Hall R.N,\nChairman\nin time of disaster, enrolled Red Cross\nSecretary.\nnurses should report at once to the\nSecretary of the Local Committee under\nAlameda Co,\nLocal Committee.\nwhich they are enrolled.\nthe address of the Secretary\nName in full\nDo not forget mainor 6101 Donegater Place Ceak, Caly,\nIf married, give husband's name\nPermanent address 2508 (STREET, ashbyour ETC.) Berkelly (CITY) alameda (COUNTY) Dated \\(STATE)\nProbable address for the next year\nTel ephone No. Thom 0094\n25-08 (STREET, ETC.) Ave Burbetting\nashthy\n(CITY)\n(COUNTY)\n(STATE)\nName and address of nearest relative or friend, in United States, through whom you may\ncommunicated with in an emergency. State relationship)\nUnderline be Mrs the CM. would Cherokee Olela - (sinter)\ntype 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? no\nHave you ever been?\nyes\nIndicate present physical condition\nConvelectent.\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.?\nBadge No. 15337\nCurrent date\n1931\nNOTE. If the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrolment will be annulled."
}