Jack, James

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

Reference Number: 
SMC/3/4/1/7 2:3
Name of Practitioner (Surname): 
Jack
(Christian Names in Full): 
James
Qualifications: 
MD
Address: 
Craigbank
City/Town: 
Kilwinning
Present Work: 

General Practitioner and Panel. Parish Council MO MO Joint Hospital Kilwinning

Age as at 1st January 1916: 
48
Group B (45 to 55) Part-time home civil work: 
X in red circle

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 and note in B band] presently doing this.

Date Form Signed: 
29/12/1915

To be returned to

The Secretary,

Scottish Medical Service Emergency Committee,

Royal College of Physicians,

Edinburgh.