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FORM 1045 REV. 2-16-31 NATIONAL OFFICERS CENTRAL COMMITTEE HERBERT HOOVER, PRESIDENT JOHN BARTON PAYNE, CHAIRMAN MRS. AUGUST BELMONT ROBERT W. DE FOREST. VICE PRESIDENT 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 HENRY UPSON SIMS ERNEST P. BICKNELL. VICE CHAIRMAN THOMAS D. THACHER JAMES K. McCLINTOCK, VICE CHAIRMAN ELIOT WADSWORTH max. 12-33 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: Yours sincerely, In order to render prompt service Chairman or in time of disaster, enrolled Red Cross MISS FLORENCE BLACK Secretary. Nurses should report at once to the SHELTERING ARMS HOSPITALS Secretary of the Local Committee under RICHMOND, VIRGINIA Local Committee. which they are enrolled. Do not forget the address of the Secretary. Name in full Namine Jac guslin Minor If married, give husband's name Permanent address 209n. Phim Richmond Vingania STREET, ETC. CITY COUNTY STATE Probable address for the next year 209 h. Phin st STREET, ETC. Telephone No What 46857 Richmond very 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, John B minor 1702 Parke are Dial 4.8904 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 - Registrar. Are you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? no Have you ever been? m Indicate present physical condition Fair Would you respond to an emergency call in event of epidemic, disaster, war, etc.? Insuranced Badge No. 1338 Current date march 3 1932 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. 2-16-31\nNATIONAL OFFICERS\nCENTRAL COMMITTEE\nHERBERT HOOVER, PRESIDENT\nJOHN BARTON PAYNE, CHAIRMAN\nMRS. AUGUST BELMONT\nROBERT W. DE FOREST. VICE PRESIDENT\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\nHENRY UPSON SIMS\nERNEST P. BICKNELL. VICE CHAIRMAN\nTHOMAS D. THACHER\nJAMES K. McCLINTOCK, VICE CHAIRMAN\nELIOT WADSWORTH\nmax. 12-33\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:\nYours sincerely,\nIn order to render prompt service\nChairman or\nin time of disaster, enrolled Red Cross\nMISS FLORENCE BLACK\nSecretary.\nNurses should report at once to the\nSHELTERING ARMS HOSPITALS\nSecretary of the Local Committee under\nRICHMOND, VIRGINIA\nLocal Committee.\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nName in full Namine Jac guslin Minor\nIf married, give husband's name\nPermanent address\n209n. Phim\nRichmond\nVingania\nSTREET, ETC.\nCITY\nCOUNTY\nSTATE\nProbable address for the next year\n209 h. Phin st\nSTREET, ETC.\nTelephone No What 46857\nRichmond\nvery\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)\nBrother, John B minor 1702 Parke are Dial 4.8904\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 -\nRegistrar.\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick?\nno\nHave you ever been? m\nIndicate present physical condition Fair\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.?\nInsuranced\nBadge No. 1338\nCurrent date march 3 1932\nNOTE. -If the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrolment will be annulled."
}