33. Are you willing to serve in Civil Hospitals from which
personnel have been withdrawn for War Service?

34. Are you willing to serve:--

(a) With pay,
(b) For expenses only,
on the terms of service laid down in our terms of service?

N. B.--Members who can afford to work for their expenses only are
urgently needed.

35. Date after which you will be available for duty.

36. (a) Are you pledged to serve in any other organisation?
(b) If so, what?

37. (a) Have you served with the Women's Legion or any
similar organisation?
(b) If so, what?

I hereby declare that the above statements are complete and correct to
the best of my knowledge and belief.

Date .......... Usual Signature ..........

_For Office Purposes_, please add your full Christian Names and Surname
legibly written.