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FORM 1045
REV. 12-3-37
THE AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. C.
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
LUCY M. BAYLEY)
Chairman or
Nurses should report at once to the
Secretary.
Secretary of the Local Committee under
37 S. GOODMAN ST.
which they are enrolled. Do not forget
ROCHESTED
Local Committee.
the address of the Secretary.
Name in full
Marjory Storey
If married, give husband's name
Permanent address
30 Hortens? St. Rochester
Monros
Dew Hark
(STREET, ETC.)
(CITY)
(COUNTY)
(STATE)
Probable address for the next year
.)
(STREET, ETC.)
Telephone
No. genera 4774
(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)
(Sister) Mrs James Spinning 578 writtington ave Rochestar n.y
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?
Indicate present physical condition good
Would you respond emergency call in epidemic, disaster, way, etc. yes
to an event of ?
Badge No. 41828
Current
date March 31,1938
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.
E
82
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"ocrText": "of\nFORM 1045\nREV. 12-3-37\nTHE AMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\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\nLUCY M. BAYLEY)\nChairman or\nNurses should report at once to the\nSecretary.\nSecretary of the Local Committee under\n37 S. GOODMAN ST.\nwhich they are enrolled. Do not forget\nROCHESTED\nLocal Committee.\nthe address of the Secretary.\nName in full\nMarjory Storey\nIf married, give husband's name\nPermanent address\n30 Hortens? St. Rochester\nMonros\nDew Hark\n(STREET, ETC.)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address for the next year\n.)\n(STREET, ETC.)\nTelephone\nNo. genera 4774\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)\n(Sister) Mrs James Spinning 578 writtington ave Rochestar n.y\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?\nIndicate present physical condition good\nWould you respond emergency call in epidemic, disaster, way, etc. yes\nto an event of ?\nBadge No. 41828\nCurrent\ndate March 31,1938\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.\nE\n82"
}