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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."
}