Enrollment Form

Form No. 469-(2) THE AMERICAN RED CROSS ENROLLMENT FORM M W Atlantic Division Voyage number To THE DIVISION OF TRANSPORTATION, Freersing Department BUREAU OF PERSONNEL. DWarch 1, 1920. Approval of Director, Approved Clara Daying Bureau of Personnel 1. Name Agnes H. VonKurowsky 2. Addres426 East 26th Street, New York City, NY. 3. Temporary address, if any Club Drive, Woodmere, L.I., NY. c/o Mrs. Max Bruell (For next few weeks) 4. Going to what countries Russia 5. Nature of work Enrolled Red Cross Nurse 6. Suggested rank 7. Length of stay (six months or over ?c year or more 8. Proposed approximate date of departure Booked Sailed 3/19 9. Cable number in compliance with which above is being sen 20903 10. Is appointee volunteer? No day of departure 11. If not volunteer, what salary per month is promised 70.00 12. To begin New York 13. What allowance, if any, for transportation in United States? to New York and return 14. What allowance, if any, for transportation (steamship) ? $0 destinati on and return 4.00 day from date requested to 15. What allowance, if any, for living expenses prior to departure in N.Y. to day of sailing 16. What allowance, if any, for uniform equipment? $ yes, requisitioned at N.Y. office 17. What allowance, if any, for living expenses abroad? yes, regulat ion al lowance. 18. Is there to be an assignment of part or all of salary ? 19. Has the proper form been sent to the Life Extension Institute? Division of Transportation, PLEASE LEAVE THE FOLLOWING LINES BLANK. Correspondence checked: Note Forms Mailed Clerk of the Court at Application for passport filed Date Issued Reservation Cancelled Cabled Cancelled Date of birth - January 5, 1892.