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Form 1045 Rev. 1-7-30
NATIONAL OFFICERS
CENTRAL COMMITTEE
JOHN BARTON PAYNE, CHAIRMAN
-
3
HERBERT HOOVER, PRESIDENT
ROBERT W. DE FOREST. VICE PRESIDENT
MRS. AUGUST BELMONT
THE AMERICAN RED CROSS
CORNELIUS N. BLISS
rs.
WILLIAM HOWARD TAFT, VICE PRESIDENT
MABEL T. BOARDMAN
PCALWIN COOLIDGE, VICE PRESIDENT
JOSEPH P. COTTON
CHARLES EVANS HUGHES, JR., COUNSELOR
NATIONAL HEADQUARTERS
MRS. HENRY P. DAVISON
E. B. DOUGLAS
OGDEN L, MILLS, TREASURER
WASHINGTON, D.C.
MRS. FRANK v. HAMMAR
MABEL T. BOARDMAN, SECRETARY
CHARLES EVANS HUGHES, JR.
M
I
MAJ. GEN. M. w. IRELAND
SAMUEL KNIGHT
NATIONAL EXECUTIVE OFFICERS
OGDEN L. MILLS
GUSTAVUS D. POPE
JOHN BARTON PAYNE, CHAIRMAN
MRS. HENRY R. REA
REAR ADMIRAL CHARLES E. RIGGS
ari
e
JAMES L. FIESER, VICE CHAIRMAN
JOHN D. RYAN
ERNEST P. BICKNELL. VICE CHAIRMAN
GEORGE E, SCOTT
JAMES K. MECLINTOCK.VICE CHAIRMAN
ELIOT WADSWORTH
-
Dear Madam:
0
M
a
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
S
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
I
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
Chairman or
Mrs. Mabel C. Collins,
nurses should report at once to the
Segretary
17 Ridge St.
Secretary of the Local Committee under
Greenwich, Conn.
which they are enrolled. Do not forget
Local Committee.
the address of the Secretary.
Name
in full Helen muriel Godsoe offer
If
married, give husband's name Hearry B. offen
Permanent address new (CITY) common (COUNTY) Come (STATE)
Stanfonderous
(STREET, ETED
Probable address for the next year
same
(STREET. ETC.)
Tel ephone No. 425
same are above
(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) Husband
Underline the /type of
stormand
work ave, new Canaerm com
you are now doing: - Army - Navy - U.S.P.H. Hospital - U.S.Vet. Hospital - 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?
no
Indicate present physical condition
not very good
Would you respond to an emergency call in event of epidemic, disaster, war,etc.? no
2
Badge No. 22964
Current date march able 1931
2
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": "I\nF\near\nF\nI\nForm 1045 Rev. 1-7-30\nNATIONAL OFFICERS\nCENTRAL COMMITTEE\nJOHN BARTON PAYNE, CHAIRMAN\n-\n3\nHERBERT HOOVER, PRESIDENT\nROBERT W. DE FOREST. VICE PRESIDENT\nMRS. AUGUST BELMONT\nTHE AMERICAN RED CROSS\nCORNELIUS N. BLISS\nrs.\nWILLIAM HOWARD TAFT, VICE PRESIDENT\nMABEL T. BOARDMAN\nPCALWIN COOLIDGE, VICE PRESIDENT\nJOSEPH P. COTTON\nCHARLES EVANS HUGHES, JR., COUNSELOR\nNATIONAL HEADQUARTERS\nMRS. HENRY P. DAVISON\nE. B. DOUGLAS\nOGDEN L, MILLS, TREASURER\nWASHINGTON, D.C.\nMRS. FRANK v. HAMMAR\nMABEL T. BOARDMAN, SECRETARY\nCHARLES EVANS HUGHES, JR.\nM\nI\nMAJ. GEN. M. w. IRELAND\nSAMUEL KNIGHT\nNATIONAL EXECUTIVE OFFICERS\nOGDEN L. MILLS\nGUSTAVUS D. POPE\nJOHN BARTON PAYNE, CHAIRMAN\nMRS. HENRY R. REA\nREAR ADMIRAL CHARLES E. RIGGS\nari\ne\nJAMES L. FIESER, VICE CHAIRMAN\nJOHN D. RYAN\nERNEST P. BICKNELL. VICE CHAIRMAN\nGEORGE E, SCOTT\nJAMES K. MECLINTOCK.VICE CHAIRMAN\nELIOT WADSWORTH\n-\nDear Madam:\n0\nM\na\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\nS\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\nI\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\nChairman or\nMrs. Mabel C. Collins,\nnurses should report at once to the\nSegretary\n17 Ridge St.\nSecretary of the Local Committee under\nGreenwich, Conn.\nwhich they are enrolled. Do not forget\nLocal Committee.\nthe address of the Secretary.\nName\nin full Helen muriel Godsoe offer\nIf\nmarried, give husband's name Hearry B. offen\nPermanent address new (CITY) common (COUNTY) Come (STATE)\nStanfonderous\n(STREET, ETED\nProbable address for the next year\nsame\n(STREET. ETC.)\nTel ephone No. 425\nsame are above\n(CITY)\n(COUNTY)\n(STATE)\nName and address of nearest relative or friend, in United States, through whom you may\nbe\ncommunicated with in an emergency. (State relationship) Husband\nUnderline the /type of\nstormand\nwork ave, new Canaerm com\nyou are now doing: - Army - Navy - U.S.P.H. Hospital - U.S.Vet. Hospital - Public\nHealth - Institutional - Private Duty - Industrial - Office Nurse - Registrar.\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? no\nHave you ever been?\nno\nIndicate present physical condition\nnot very good\nWould you respond to an emergency call in event of epidemic, disaster, war,etc.? no\n2\nBadge No. 22964\nCurrent date march able 1931\n2\nNOTE. - If the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrolment will be annulled."
}