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Form 1045 Rev. 1-7-30
NATIONAL OFFICERS
CENTRAL COMMITTEE
JOHN BARTON PAYNE, CHAIRMAN
HERBERT HOOVER, PRESIDENT
MRS. AUGUST BELMONT
ROBERT w. DE FOREST. VICE PRESIDENT
CORNELIUS N. BLISS
WILLIAM HOWARD TAFT. VICE PRESIDENT
THE AMERICAN RED CROSS
MABEL T. BOARDMAN
JOSEPH P. COTTON
CALVIN COOLIDGE, VICE PRESIDENT
MRS. HENRY P. DAVISON
CHARLES EVANS HUGHES, JR,, COUNSELOR
NATIONAL HEADQUARTERS
E.B. DOUGLAS
OGDEN L. MILLS, TREASURER
MRS. FRANK v. HAMMAR
WASHINGTON, D.C.
CHARLES EVANS HUGHES, JR.
0
MABEL T. BOARDMAN. SECRETARY
MAJ. GEN. M. w. IRELAND
JOHN BARTON PAYNE, CHAIRMAN
34/2 for
SAMUEL KNIGHT
OGDEN L. MILLS
S
NATIONAL EXECUTIVE OFFICERS
GUSTAVUS D. POPE
MRS. HENRY R. REA
REAR ADMIRAL CHARLES E. RIGGS
6
JAMES L. FIESER, VICE CHAIRMAN
JOHN D. RYAN
ERNEST P. BICKNELL, VICE CHAIRMAN
GEORGE E, SCOTT
ELIOT WADSWORTH
JAMES K. McCLINTOCK. VICE CHAIRMAN
5
Dear Madam:
e
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
D
Headquarters and ask for your cooperation. Please answer the following questions and
return this form to me, in enclosed envelope, at the earliest possible date,
IMPORTANT:
In order to render prompt service
Yours sincerely,
in time of disaster, enrolled Red Cross
ELLA E. McNEIL, R.i..
Chairman or
nurses should report at once to the
STREET
Secretary.
Secretary of the Local Committee under
PHILADELPHIA, PENNA.
which they are enrolled. Do not forget
Local Committee.
the address of the Secretary.
Name in full Josefains Clay
If married, give husband's name
Permanent address 90 Curtis (STREET, ETC.) Li Clay 1600achast (CITY) have Bhile (COUNTY)
Pa.
(STATE)
Probable address for the next year
(STREET, ETC.)
Tel ephone No.
(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)
Underline
Anthi the di Clay typé of 1600 work arch st Plula
Brother
you are now doingl - Army - Navy - U.S.P.H Hospital - U.S.Vet. Hospital - Public
Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar.
Have you ever been? Two
Are you
an instructor of Red Cross classes in Home Hygiene and Care of the Sick? us
Indicate present physical condition good
Would you respond to an emergency call in event of epidemic, disaster, war, etc.?
Badge No. 5408
Current date
3/18/30
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 Rev. 1-7-30\nNATIONAL OFFICERS\nCENTRAL COMMITTEE\nJOHN BARTON PAYNE, CHAIRMAN\nHERBERT HOOVER, PRESIDENT\nMRS. AUGUST BELMONT\nROBERT w. DE FOREST. VICE PRESIDENT\nCORNELIUS N. BLISS\nWILLIAM HOWARD TAFT. VICE PRESIDENT\nTHE AMERICAN RED CROSS\nMABEL T. BOARDMAN\nJOSEPH P. COTTON\nCALVIN COOLIDGE, VICE PRESIDENT\nMRS. HENRY P. DAVISON\nCHARLES EVANS HUGHES, JR,, COUNSELOR\nNATIONAL HEADQUARTERS\nE.B. DOUGLAS\nOGDEN L. MILLS, TREASURER\nMRS. FRANK v. HAMMAR\nWASHINGTON, D.C.\nCHARLES EVANS HUGHES, JR.\n0\nMABEL T. BOARDMAN. SECRETARY\nMAJ. GEN. M. w. IRELAND\nJOHN BARTON PAYNE, CHAIRMAN\n34/2 for\nSAMUEL KNIGHT\nOGDEN L. MILLS\nS\nNATIONAL EXECUTIVE OFFICERS\nGUSTAVUS D. POPE\nMRS. HENRY R. REA\nREAR ADMIRAL CHARLES E. RIGGS\n6\nJAMES L. FIESER, VICE CHAIRMAN\nJOHN D. RYAN\nERNEST P. BICKNELL, VICE CHAIRMAN\nGEORGE E, SCOTT\nELIOT WADSWORTH\nJAMES K. McCLINTOCK. VICE CHAIRMAN\n5\nDear Madam:\ne\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\nD\nHeadquarters and ask for your cooperation. Please answer the following questions and\nreturn this form to me, in enclosed envelope, at the earliest possible date,\nIMPORTANT:\nIn order to render prompt service\nYours sincerely,\nin time of disaster, enrolled Red Cross\nELLA E. McNEIL, R.i..\nChairman or\nnurses should report at once to the\nSTREET\nSecretary.\nSecretary of the Local Committee under\nPHILADELPHIA, PENNA.\nwhich they are enrolled. Do not forget\nLocal Committee.\nthe address of the Secretary.\nName in full Josefains Clay\nIf married, give husband's name\nPermanent address 90 Curtis (STREET, ETC.) Li Clay 1600achast (CITY) have Bhile (COUNTY)\nPa.\n(STATE)\nProbable address for the next year\n(STREET, ETC.)\nTel ephone No.\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.\n(State relationship)\nUnderline\nAnthi the di Clay typé of 1600 work arch st Plula\nBrother\nyou are now doingl - Army - Navy - U.S.P.H Hospital - U.S.Vet. Hospital - Public\nHealth - Institutional - Private Duty - Industrial - Office Nurse - Registrar.\nHave you ever been? Two\nAre you\nan instructor of Red Cross classes in Home Hygiene and Care of the Sick? us\nIndicate present physical condition good\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.?\nBadge No. 5408\nCurrent date\n3/18/30\nNOTE. . - If the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrolment will be annulled."
}