Evans, Owen Glendower

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

Reference Number: 
SMC/3/4/1/4 1:3
Name of Practitioner (Surname): 
Evans
(Christian Names in Full): 
Owen Glendower
Qualifications: 
LRCP&SE, LRFP&SS
Address: 
Eskdale Cottage
City/Town: 
Stow
Present Work: 

Qualified Oct 1916

Age as at 1st January 1916: 
26
Group A (Under 45) Lieut., R.A.M.C. (general service): 

X (and circled in red by SMSEC)

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.

Date Form Signed: 
22/03/1917

To be returned to

The Secretary,

Scottish Medical Service Emergency Committee,

Royal College of Physicians,

Edinburgh.