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Fo 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
in time of disaster, enrolled Red Cross
Secretary.
nurses should report at once to the
Secretary of the Local Committee under
Local Committee.
which they are enrolled. Do not forget
the address of the Secretary.
Name in full
If married, give husband's name
Permanent address
(STREET, ETC.)
Probable address for the next year
1109 (CITYY Sau autoun (COUNTY)
(STATE)
No. alamuda 5324
alameda
(STREET, ETC.)
Telephone
(CITY)
(COUNTY)
Callif
(STATE)
Name and address of nearest relative or friend, in United States, through whom you may
be communicated with in an emergency.
Mrs FA. the type memours of work
(State 1109 relationship) San
Underline
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?
Indicate present physical condition
good
Would you respond to an emergency call in event of epidemic, disaster, war, etc.?
Yes
Badge No. 15337
Current date
May 8th 1930 be
NOTE.--I the nurse does not complete and return this questionnaire, and can not
located within two years, her enrolment will be annulled.
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"ocrText": "Fo 1045 Rev. 1-7-30\nNATIONAL OFFICERS\n+\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\nin time of disaster, enrolled Red Cross\nSecretary.\nnurses should report at once to the\nSecretary of the Local Committee under\nLocal Committee.\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nName in full\nIf married, give husband's name\nPermanent address\n(STREET, ETC.)\nProbable address for the next year\n1109 (CITYY Sau autoun (COUNTY)\n(STATE)\nNo. alamuda 5324\nalameda\n(STREET, ETC.)\nTelephone\n(CITY)\n(COUNTY)\nCallif\n(STATE)\nName and address of nearest relative or friend, in United States, through whom you may\nbe communicated with in an emergency.\nMrs FA. the type memours of work\n(State 1109 relationship) San\nUnderline\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?\nIndicate present physical condition\ngood\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.?\nYes\nBadge No. 15337\nCurrent date\nMay 8th 1930 be\nNOTE.--I the nurse does not complete and return this questionnaire, and can not\nlocated within two years, her enrolment will be annulled."
}