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Ave.
Local Committee.
---- nurses should report at
once to the Secretary of the Local
Ann Arbor, Mich.
Committee under which they are en-
rolled. Do not forget the address
Name in full clarice Hunt Wanam ahu
of the Secretary.
Age HM
If married, give husband's name Funk E Examanicks 1-
Permanent address. P-3 Ghana Ledge Earn much
(Street, etc.)
(City)
(County)
(State)
Address for the next year same
(Street, etc.)
Telephone No. 310- 3
(City)
(County)
(State)
Name and address of nearest relative or friend, in United States, through whom you
may Whiltenre Dilars mich
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 instructor of Red Cross classes in Home Hygiene and Care of the Sick? The
Have you ever been?
no
Indicate present physical condition grown
Yes
Would you respond to an emergency call in event of epidemic, disaster, war, etc. ?.
Badge No. 22398
Current date Mer 24/8/2
NOTE - If the nurse does not complete and return this questionnaire, and can not be
located within two years, her enrollment will be annulled.
Form 1045.
D=653
2
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- Type
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Document data
- ID
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"ocrText": "Ave.\nLocal Committee.\n---- nurses should report at\nonce to the Secretary of the Local\nAnn Arbor, Mich.\nCommittee under which they are en-\nrolled. Do not forget the address\nName in full clarice Hunt Wanam ahu\nof the Secretary.\nAge HM\nIf married, give husband's name Funk E Examanicks 1-\nPermanent address. P-3 Ghana Ledge Earn much\n(Street, etc.)\n(City)\n(County)\n(State)\nAddress for the next year same\n(Street, etc.)\nTelephone No. 310- 3\n(City)\n(County)\n(State)\nName and address of nearest relative or friend, in United States, through whom you\nmay Whiltenre Dilars mich\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 -\nPublic Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? The\nHave you ever been?\nno\nIndicate present physical condition grown\nYes\nWould you respond to an emergency call in event of epidemic, disaster, war, etc. ?.\nBadge No. 22398\nCurrent date Mer 24/8/2\nNOTE - If the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrollment will be annulled.\nForm 1045.\nD=653\n2"
}