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B
S
S.
E
FORM 1045
THE AMERICAN RED CROSS
REV. 1-2-35
m
NATIONAL HEADQUARTERS
WASHINGTON, D. c.
15 QUESTIONNAIRES DESTROYED "
3
"
N
V
C
Dear Madam:
The National Committee on Red Cross Nursing Service requires us to submit,
enclosed envelope, at the earliest possible date? THIS ANNUAL QUESTIONNAIRE IS FILED
Nigh
Z
annually, a report of all the Red Cross Nurses enrolled with our Committee. Will you
Mrs.
M
therefore, please answer the following questions and return this form to me, in the
WITH YOUR RECORDS AT NATIONAL HEADQUARTERS IN WASHINGTON, D. C. We hope you will rec-
+i
C.
ognize the value of filing this information and will return the questionnaire promptly,
as
we are extremely anxious to make a very complete report to National Headquarters.
to
IMPORTANT:
Yours sincerely,
In order to render prompt service
in time of disaster, enrolled Red Cross
Miss FLORENCE M. JONES
Chairman or
Nurses should report at once to the
SEC,,-LOCAL-GOMMIFTEE
Secretary.
RED CROSS NURSING SERVICE
Secretary of the Local Committee under
350 CONGRESS AVENUE
which they are enrolled. Do not forget
'NEW THAVEN; CONNECTICUT
Local Committee.
the address of the Secretary.
Name in full
Emily Porter Bliss
If married, give husband's name
Clarence J.Tlliss
Permanent address
183 Bradley st newHaren
Cotrn
(STREET, ETC.)
(CITY)
(COUNTY)
(STATE)
Probable address for the next year
"
"
:
:
(STREET, ETC.)
Telephone No. 8-1665
(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)
Husband
Underline the type of work you are now doing:
Army - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service -
Public Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar.
Hourly
Are you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? no
2
Have you ever been?
Indicate present physical condition Excellent-
Would you respond to an emergency call in event of epidemic, disaster, war, etc. ? yes
Badge No. 14787
Current date Jan26-1938-
NOTE. - If the nurse does not complete and return this questionnaire, and can not be
located within two years, her enrolment will be removed from our active files.
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Document data
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- Core
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- Type
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DTO data
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Context sent to Scholar
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"ocrText": "B\nS\nS.\nE\nFORM 1045\nTHE AMERICAN RED CROSS\nREV. 1-2-35\nm\nNATIONAL HEADQUARTERS\nWASHINGTON, D. c.\n15 QUESTIONNAIRES DESTROYED \"\n3\n\"\nN\nV\nC\nDear Madam:\nThe National Committee on Red Cross Nursing Service requires us to submit,\nenclosed envelope, at the earliest possible date? THIS ANNUAL QUESTIONNAIRE IS FILED\nNigh\nZ\nannually, a report of all the Red Cross Nurses enrolled with our Committee. Will you\nMrs.\nM\ntherefore, please answer the following questions and return this form to me, in the\nWITH YOUR RECORDS AT NATIONAL HEADQUARTERS IN WASHINGTON, D. C. We hope you will rec-\n+i\nC.\nognize the value of filing this information and will return the questionnaire promptly,\nas\nwe are extremely anxious to make a very complete report to National Headquarters.\nto\nIMPORTANT:\nYours sincerely,\nIn order to render prompt service\nin time of disaster, enrolled Red Cross\nMiss FLORENCE M. JONES\nChairman or\nNurses should report at once to the\nSEC,,-LOCAL-GOMMIFTEE\nSecretary.\nRED CROSS NURSING SERVICE\nSecretary of the Local Committee under\n350 CONGRESS AVENUE\nwhich they are enrolled. Do not forget\n'NEW THAVEN; CONNECTICUT\nLocal Committee.\nthe address of the Secretary.\nName in full\nEmily Porter Bliss\nIf married, give husband's name\nClarence J.Tlliss\nPermanent address\n183 Bradley st newHaren\nCotrn\n(STREET, ETC.)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address for the next year\n\"\n\"\n:\n:\n(STREET, ETC.)\nTelephone No. 8-1665\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)\nHusband\nUnderline the type of work you are now doing:\nArmy - Navy - U.S.P.H. Service - Veterans Administration - U.S. Indian Service -\nPublic Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar.\nHourly\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? no\n2\nHave you ever been?\nIndicate present physical condition Excellent-\nWould you respond to an emergency call in event of epidemic, disaster, war, etc. ? yes\nBadge No. 14787\nCurrent date Jan26-1938-\nNOTE. - If the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrolment will be removed from our active files."
}