Burns, Charles

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

Reference Number: 
SMC/3/4/1/2 4:4
Name of Practitioner (Surname): 
Burns
(Christian Names in Full): 
Charles
Qualifications: 
MB, ChB
Address: 
12 Ann Street
City/Town: 
Stonehaven
Present Work: 

General Practitioner (Panel)

Age as at 1st January 1916: 
36
Group A (Under 45) Lieut., R.A.M.C. (general service): 

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: 

[letter attached to form] [numbers written and cross out by practitioner on bottom of page]

Date Form Signed: 
17/06/1916

To be returned to

The Secretary,

Scottish Medical Service Emergency Committee,

Royal College of Physicians,

Edinburgh.