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FORM 1045
REV. 4-4-38
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. c.
e
Dear Red Cross Nurse:
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:
In order to render prompt service
Yours sincerely,
in time of disaster, enrolled Red Cross
PLORENCE M. JOHNSON
Chairman or
Nurses should report at once to the
Secretary.
MANHATTAN
Secretary of the Local Committee under
which they are enrolled. Do not forget
Local Committee.
the address of the Secretary.
Name
in full Beatrice Page
If married, give husband's name
Permanent address Central Club 132 E.45 Sl - new york
(STREET. ETC.)
(CITY)
(COUNTY)
(STATE)
Probable address for the next year
same
(STREET, ETC.)
Telephone No Murray Her 2- - 8700
(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)
central club for nurses
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.
Are you an instructor of Red Cross classes in Home Hygiene and Care of the Sick?
Have you ever been? eyes Would you like to teach Red Cross classes? yes
Indicate present physical condition Fairly Good
Would you respond to an emergency call in event of epidemic, disaster, war, etc.? yes
Badge No. 725
Current date 3/13/29
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": "1\nFORM 1045\nREV. 4-4-38\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. c.\ne\nDear Red Cross Nurse:\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:\nIn order to render prompt service\nYours sincerely,\nin time of disaster, enrolled Red Cross\nPLORENCE M. JOHNSON\nChairman or\nNurses should report at once to the\nSecretary.\nMANHATTAN\nSecretary of the Local Committee under\nwhich they are enrolled. Do not forget\nLocal Committee.\nthe address of the Secretary.\nName\nin full Beatrice Page\nIf married, give husband's name\nPermanent address Central Club 132 E.45 Sl - new york\n(STREET. ETC.)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address for the next year\nsame\n(STREET, ETC.)\nTelephone No Murray Her 2- - 8700\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)\ncentral club for nurses\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.\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick?\nHave you ever been? eyes Would you like to teach Red Cross classes? yes\nIndicate present physical condition Fairly Good\nWould you respond to an emergency call in event of epidemic, disaster, war, etc.? yes\nBadge No. 725\nCurrent date 3/13/29\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."
}