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S M an a 1 , ph. FORM 1045 REV. 1-2-35 Fren T THE AMERICAN RED CROSS D NATIONAL HEADQUARTERS ci = WASHINGTON, D. c. ce Dear Madam: The National Committee on Red Cross Nursing Service requires us to submit, annually, a report of all the Red Cross Nurses enrolled with our Committee. Will you therefore, please answer the following questions and return this form to me, in the enclosed envelope, at the earliest possible date? THIS ANNUAL QUESTIONNAIRE IS FILED WITH YOUR RECORDS AT NATIONAL HEADQUARTERS IN WASHINGTON, D. C. We hope you will rec- 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. IMPORTANT: Yours sincerely, Chairman or In order to render prompt service in time of disaster, enrolled Red Cross CARRIE. E, MAAKESTAD Secretary. Nurses should report at once to the SAN FRANCISCO HOSPITAL Secretary of the Local Committee under SAN.F.BANCISCO, GALIF: Local Committee. which they are enrolled. Do not forget the address of the Secretary. Name in full alies U, mesply Permanent married, address give husband's 580 name mcallister & San Vanciees, If (STREET, ETC.) (CITY) (COUNTY) (STATE) Probable address for the next year paur MX (STREET ETC.) above Telephone Nombly 9472 (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) muss m E Friis (friend) 580 meallister Sh. S.f Real 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. you an instructor Hospital Red Cross classes muser in Home Hygiene surer and Care 1925 of the Sick? no Are Have you ever been? mo Indicate present physical condition Tray food Would you respond to an emergency call in event of epidemic, march disaster, war, etc.: for Badge No. Current date 25, 1937 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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    "ocrText": "S\nM\nan\na\n1\n, ph.\nFORM 1045\nREV. 1-2-35\nFren\nT\nTHE AMERICAN RED CROSS\nD\nNATIONAL HEADQUARTERS\nci\n=\nWASHINGTON, D. c.\nce\nDear Madam:\nThe National Committee on Red Cross Nursing Service requires us to submit,\nannually, a report of all the Red Cross Nurses enrolled with our Committee. Will you\ntherefore, please answer the following questions and return this form to me, in the\nenclosed envelope, at the earliest possible date? THIS ANNUAL QUESTIONNAIRE IS FILED\nWITH YOUR RECORDS AT NATIONAL HEADQUARTERS IN WASHINGTON, D. C. We hope you will rec-\nognize the value of filing this information and will return the questionnaire promptly,\nas we are extremely anxious to make a very complete report to National Headquarters.\nIMPORTANT:\nYours sincerely,\nChairman or\nIn order to render prompt service\nin time of disaster, enrolled Red Cross\nCARRIE. E, MAAKESTAD\nSecretary.\nNurses should report at once to the\nSAN FRANCISCO HOSPITAL\nSecretary of the Local Committee under\nSAN.F.BANCISCO, GALIF:\nLocal Committee.\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nName in full\nalies U, mesply\nPermanent married, address give husband's 580 name mcallister & San Vanciees,\nIf\n(STREET, ETC.)\n(CITY)\n(COUNTY)\n(STATE)\nProbable\naddress for the next year paur MX (STREET ETC.) above\nTelephone Nombly 9472\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)\nmuss m E Friis (friend) 580 meallister Sh. S.f Real\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.\nyou an instructor Hospital Red Cross classes muser in Home Hygiene surer and Care 1925 of the Sick?\nno\nAre\nHave you ever been?\nmo\nIndicate present physical condition Tray food\nWould\nyou respond to an emergency call in event of epidemic, march disaster, war, etc.: for\nBadge No.\nCurrent date 25, 1937\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."
}