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Special
FORM 1045 REV. 2-16-31
NATIONAL OFFICERS
CENTRAL COMMITTEE
HERBERT HOOVER, PRESIDENT
JOHN BARTON PAYNE, CHAIRMAN
ROBERT w. DE FOREST. VICE PRESIDENT
MRS. AUGUST BELMONT
THE AMERICAN RED CROSS
CORNELIUS N. BLISS
CALVIN COOLIDGE, VICE PRESIDENT
MABEL T. BOARDMAN
CHARLES EVANS HUGHES, VICE PRESIDENT
JOSEPH P. COTTON
THOMAS D. THACHER, COUNSELOR
NATIONAL HEADQUARTERS
MRS HENRY P. DAVISON
MRS. FRANK v. HAMMAR
OGDEN L. MILLS, TREASURER
WASHINGTON, D.C.
MAJ. GEN M. w. IRELAND
MABEL T. BOARDMAN. SECRETARY
SAMUEL KNIGHT
OGDEN L. MILLS
GUSTAVUS D. POPE
NATIONAL EXECUTIVE OFFICERS
MRS, HENRY R REA
REAR ADMIRAL CHARLES E. RIGGS
JOHN BARTON PAYNE, CHAIRMAN
JOHN D. RYAN
JAMES L. FIESER, VICE CHAIRMAN
GEORGE E. SCOTT
ERNEST P. BICKNELL, VICE CHAIRMAN
HENRY UPSON SIMS
THOMAS D. THACHER
JAMES K. MCCLINTOCK, VICE CHAIRMAN
ELIOT WADSWORTH
miss game Hilehird Whitney. Hailford
Come
march 23/31
Dear Madam:
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
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
Nurses should report at once to the
Harried E Chairman Secretary.
or
Secretary of the Local Committee under
which they are enrolled. Do not forget
Strutfuel
Local Committee.
the address of the Secretary.
Name in
full Jane Elizabeth Hitchcock.
If married, give husband's name
Un married
Permanent address 185, So Whitney. St, - Hartford- CITY Hartford
Conn
Contemptate change. willnoti ETC. ty.
COUNTY
STATE
Probable address for the next year
STREET, ETC.
Telephone No. 4-8437
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) Brother
Albert White Hitchcock 183 Bawthorn ST. - -Hartford, Conn.
Underline the type of work
you are now doing: Army - Navy - U.S.P.H. Hospital - U.S. Vet. Hospital - U.S. Indian
Service - Public Health - Institutional - Private Duty - Industrial - Office Nurse
-
Are you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? no
Registrar.
Retired Public Heath nurse a Instructor
Have you ever been? yes. During world wat-
Indicate present physical condition
Excellent
Would you respond to an emergency call in event of epidemic, disaster, war, etc. ? yes
Travelling. Badge no. not-valiable.
SpecidBadge No.
Current date April - 8 - 1981
NOTE.- 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": "I\n+\nSpecial\nFORM 1045 REV. 2-16-31\nNATIONAL OFFICERS\nCENTRAL COMMITTEE\nHERBERT HOOVER, PRESIDENT\nJOHN BARTON PAYNE, CHAIRMAN\nROBERT w. DE FOREST. VICE PRESIDENT\nMRS. AUGUST BELMONT\nTHE AMERICAN RED CROSS\nCORNELIUS N. BLISS\nCALVIN COOLIDGE, VICE PRESIDENT\nMABEL T. BOARDMAN\nCHARLES EVANS HUGHES, VICE PRESIDENT\nJOSEPH P. COTTON\nTHOMAS D. THACHER, COUNSELOR\nNATIONAL HEADQUARTERS\nMRS HENRY P. DAVISON\nMRS. FRANK v. HAMMAR\nOGDEN L. MILLS, TREASURER\nWASHINGTON, D.C.\nMAJ. GEN M. w. IRELAND\nMABEL T. BOARDMAN. SECRETARY\nSAMUEL KNIGHT\nOGDEN L. MILLS\nGUSTAVUS D. POPE\nNATIONAL EXECUTIVE OFFICERS\nMRS, HENRY R REA\nREAR ADMIRAL CHARLES E. RIGGS\nJOHN BARTON PAYNE, CHAIRMAN\nJOHN D. RYAN\nJAMES L. FIESER, VICE CHAIRMAN\nGEORGE E. SCOTT\nERNEST P. BICKNELL, VICE CHAIRMAN\nHENRY UPSON SIMS\nTHOMAS D. THACHER\nJAMES K. MCCLINTOCK, VICE CHAIRMAN\nELIOT WADSWORTH\nmiss game Hilehird Whitney. Hailford\nCome\nmarch 23/31\nDear Madam:\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\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\nNurses should report at once to the\nHarried E Chairman Secretary.\nor\nSecretary of the Local Committee under\nwhich they are enrolled. Do not forget\nStrutfuel\nLocal Committee.\nthe address of the Secretary.\nName in\nfull Jane Elizabeth Hitchcock.\nIf married, give husband's name\nUn married\nPermanent address 185, So Whitney. St, - Hartford- CITY Hartford\nConn\nContemptate change. willnoti ETC. ty.\nCOUNTY\nSTATE\nProbable address for the next year\nSTREET, ETC.\nTelephone No. 4-8437\nCITY\nCOUNTY\nSTATE\nName and address of nearest relative or friend, in United States, through whom you may\nbe communicated with in an emergency. (State relationship) Brother\nAlbert White Hitchcock 183 Bawthorn ST. - -Hartford, Conn.\nUnderline the type of work\nyou are now doing: Army - Navy - U.S.P.H. Hospital - U.S. Vet. Hospital - U.S. Indian\nService - Public Health - Institutional - Private Duty - Industrial - Office Nurse\n-\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? no\nRegistrar.\nRetired Public Heath nurse a Instructor\nHave you ever been? yes. During world wat-\nIndicate present physical condition\nExcellent\nWould you respond to an emergency call in event of epidemic, disaster, war, etc. ? yes\nTravelling. Badge no. not-valiable.\nSpecidBadge No.\nCurrent date April - 8 - 1981\nNOTE.- the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrolment will be annulled."
}