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FORM 1045--REV. 2-24-27 NATIONAL OFFICERS + CENTRAL COMMITTEE CALVIN 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 WILLIAM D, MITCHELL. COUNSELOR MABEL T. BOARDMAN J. REUBEN CLARK. JR. OGDEN L. MILLS, TREASURER NATIONAL HEADQUARTERS MRS. HENRY P. DAVISON MABEL T. BOARDMAN, SECRETARY E. B. DOUGLAS WASHINGTON, D. C. MRS. FRANK V. HAMMAR HERBERT HOOVER NATIONAL EXECUTIVE OFFICERS MAJ. GEN. M. W. IRELAND SAMUEL KNIGHT JOHN BARTON PAYNE. CHAIRMAN OGDEN L. MILLS WILLIAM D. MITCHELL JAMES L. FIESER, VICE CHAIRMAN GUSTAVUS D. POPE ERNEST P. BICKNELL, VICE CHAIRMAN MRS. HENRY R. REA REAR ADMIRAL CHARLES E. RIGGS JOHN D. RYAN GEORGE E, SCOTT 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: In order to render prompt service Yours sincerely, in time of disaster, enrolled Red Cross Chairman or MRS. LEOLA ROBERTI nurses should report at once to the Secretary. 424 OCTAVIA STREET Secretary of the Local Committee under SAN FRANCISCO, CAL Local Committee. which they are enrolled. the address of the Secretary Name in full the Do not foreft momor If married, husband's Permanent address give R#3 name Bate 106 Calif 1 , Probable address for the next year 11 Telephone No. Hayward 579 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 and Care instructor of Red Cross classes in Home Hygiene of the Sick? no Have you ever been? Indicate present physical condition good health Would you respond to an emergency call in event of epidemic, disaster, war, etc.? yes Badge No. 15337 Current date much 22 19.269 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": "FORM 1045--REV. 2-24-27\nNATIONAL OFFICERS\n+\nCENTRAL COMMITTEE\nCALVIN 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\nWILLIAM D, MITCHELL. COUNSELOR\nMABEL T. BOARDMAN\nJ. REUBEN CLARK. JR.\nOGDEN L. MILLS, TREASURER\nNATIONAL HEADQUARTERS\nMRS. HENRY P. DAVISON\nMABEL T. BOARDMAN, SECRETARY\nE. B. DOUGLAS\nWASHINGTON, D. C.\nMRS. FRANK V. HAMMAR\nHERBERT HOOVER\nNATIONAL EXECUTIVE OFFICERS\nMAJ. GEN. M. W. IRELAND\nSAMUEL KNIGHT\nJOHN BARTON PAYNE. CHAIRMAN\nOGDEN L. MILLS\nWILLIAM D. MITCHELL\nJAMES L. FIESER, VICE CHAIRMAN\nGUSTAVUS D. POPE\nERNEST P. BICKNELL, VICE CHAIRMAN\nMRS. HENRY R. REA\nREAR ADMIRAL CHARLES E. RIGGS\nJOHN D. RYAN\nGEORGE E, SCOTT\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:\nIn order to render prompt service\nYours sincerely,\nin time of disaster, enrolled Red Cross\nChairman or\nMRS. LEOLA ROBERTI\nnurses should report at once to the\nSecretary.\n424 OCTAVIA STREET\nSecretary of the Local Committee under\nSAN FRANCISCO, CAL Local Committee.\nwhich they are enrolled.\nthe address of the Secretary\nName in full\nthe Do not foreft momor\nIf married, husband's\nPermanent\naddress give R#3 name Bate 106 Calif 1 ,\nProbable address for the next year\n11\nTelephone No. Hayward 579\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 and Care\ninstructor of Red Cross classes in Home Hygiene of the Sick? no\nHave you ever been?\nIndicate present physical condition\ngood health\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.?\nyes\nBadge No. 15337\nCurrent date\nmuch 22 19.269\nNOTE.--If the nurse does not complete and return this questionnaire, and can not\nbe located within two years, her enrollment will be annulled."
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