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Form 1045-A Rev. 1-7-30
NATIONAL OFFICERS
CENTRAL COMMITTEE
HERBERT HOOVER, PRESIDENT
JOHN BARTON PAYNE. CHAIRMAN
MRS. AUGUST BELMONT
ROBERT W. DE FOREST. VICE PRESIDENT
CORNELIUS N. BLISS
WILLIAM HOWARD TAFT. VICE PRESIDENT
THE AMERICAN RED CROSS
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
REAR ADMIRAL CHARLES E. RIGGS
JAMES L. FIESER, VICE CHAIRMAN
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 enrolled Red Cross Nurses with their latest addresses. We are
extremely anxious to make a very complete report and ask for your cooperation. Will
you kindly answer the following questions and return this form to me, in the enclosed
envelope, at the earliest possible date?
IMPORTANT:
Yours sincerely,
In order to render prompt service
in time of disaster, enrolled Red Cross
Clasa D.noyes
nurses should report at once to the
Secretary of the Local Committee under
National Director,
which they are enrolled. Do not forget
Red Cross Nursing Service
the address of the Secretary.
Name in full
Charl16 in Van Duzor
If married, give husband's name
Pond
Franklin
Permanent address
Norfolu
Mass
(STREET, ETC.)
(CITY)
COUNTY)
(STATE)
Probable address for the next year
same
(STREET, ETC.)
Telephone No. Franclin 689 M
(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)
R n. Holmes (Friend) same address an above
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 instructor of Red Cross classes in Home Hygiene and Care of the Sick?
No
Have you ever been?
no
Indicate present physical condition Good
ban
Would you respond to an emergency call in event of epidemic, disaster, war, etc.?
not.
Badge No.
Current date June my 4 1930
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-A Rev. 1-7-30\nNATIONAL OFFICERS\nCENTRAL COMMITTEE\nHERBERT HOOVER, PRESIDENT\nJOHN BARTON PAYNE. CHAIRMAN\nMRS. AUGUST BELMONT\nROBERT W. DE FOREST. VICE PRESIDENT\nCORNELIUS N. BLISS\nWILLIAM HOWARD TAFT. VICE PRESIDENT\nTHE AMERICAN RED CROSS\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\nREAR ADMIRAL CHARLES E. RIGGS\nJAMES L. FIESER, VICE CHAIRMAN\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 enrolled Red Cross Nurses with their latest addresses. We are\nextremely anxious to make a very complete report and ask for your cooperation. Will\nyou kindly answer the following questions and return this form to me, in the enclosed\nenvelope, at the earliest possible date?\nIMPORTANT:\nYours sincerely,\nIn order to render prompt service\nin time of disaster, enrolled Red Cross\nClasa D.noyes\nnurses should report at once to the\nSecretary of the Local Committee under\nNational Director,\nwhich they are enrolled. Do not forget\nRed Cross Nursing Service\nthe address of the Secretary.\nName in full\nCharl16 in Van Duzor\nIf married, give husband's name\nPond\nFranklin\nPermanent address\nNorfolu\nMass\n(STREET, ETC.)\n(CITY)\nCOUNTY)\n(STATE)\nProbable address for the next year\nsame\n(STREET, ETC.)\nTelephone No. Franclin 689 M\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)\nR n. Holmes (Friend) same address an above\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 instructor of Red Cross classes in Home Hygiene and Care of the Sick?\nNo\nHave you ever been?\nno\nIndicate present physical condition Good\nban\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.?\nnot.\nBadge No.\nCurrent date June my 4 1930\nNOTE. If the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrolment will be annulled."
}