Black, James David

To be filled in by a Practitioner not holding a Commission
REGISTRATION FORM
MEDICAL RECRUITING SCHEME - 1916

Reference Number: 
SMC/3/4/1/2 2:4
Name of Practitioner (Surname): 
Black
(Christian Names in Full): 
James David
Qualifications: 
LRCP&S Ed
Address: 
Templelands
City/Town: 
Dunbar
Present Work: 

Medical Officer for Oldhamstocks. Appointed Medical examiner for residents and doing work for Dr. Selkirk

Age as at 1st January 1916: 
53
Group B (45 to 55) Part-time home military work: 
X
Group B (45 to 55) Part-time home civil work: 
X
At the call of the local War Committee for my area, as instructed by the Scottish Medical Service Emergency Committee, I am prepared to render the service or services marked above. This offer is subject to the condition that, in the event of such service requiring me to leave my present work, I am enabled to make arrangements for having it carried in during my absence.
Additional Information: 
[Next to Group B 'Part-time home military work' category:] in this neighbourhood
Date Form Signed: 
28/02/1916

To be returned to

The Secretary,

Scottish Medical Service Emergency Committee,

Royal College of Physicians,

Edinburgh.