ACR Electronics 406 EPIRB, NOAA Manual

Save Time! Register your beacon online at: www.beaconregistration.noaa.gov
Official 406 MHz BEACON Registration Form
Mail or Fax to: NOAA/SARSAT E/SP3, Room 3320, FB-4, 5200 Auth Road, Suitland, MD 20746-4304

EPIRB Information

Category I (Automatic Deployment)
Category II (Manual Deployment)

EPIRB Registration

New EPIRB Registration
Renewal of EPIRB Registration
Change of EPIRB Information or Ownership

Owner/Operator Information

Name______________________________________________
Mailing Address ______________________________________
___________________________________________________
City _____________________ State/Province _____________
ZIP (Postal) Code __________ Country ___________________
E-mail ______________________________________________

Vessel Information

Usage
Commercial
Government Military
Type
Sail: Number of Masts ____________________
Power:
Fishing Tug
Other ____________________
Non-power:
Life Boat
Vessel Name _____________________________________
Vessel Color______________________________________
Survival Craft(s) on Vessel
Is your EPIRB equipped with a Simplified Voyage
Data Recorder (SVDR)?

Emergency Contact Information

Name of Primary 24-Hour Emergency Contact:
__________________________________________________
Telephone
( )_____________________
Area Code
( )_____________________
Area Code
( )_____________________
Area Code
( )_____________________
Area Code
Signature __________________________________________
If you have any questions about this form or with EPIRB registration in general, please call 1-888-212-SAVE (7283) or 301-457-5678.
For information on the U.S. Search & Rescue Satellite-Aided Tracking system, please visit: www.sarsat.noaa.gov
Beacon ID (Unique Identifier Number)
(15 digit character ID provided by EPIRB manufacturer)
Replacement of EPIRB Decal
Check here if this EPIRB is a replacement for a previously registered EPIRB.
Please enter the old EPIRB unique ID number ________________________
(Last, First, Middle Initial)
Non-commercial
Government Non-military
Cargo Tan ker Pleasure Craft
Life Raft Other__________________
Life Boat ____________________ Life Raft ____________________
No. of No. of
Yes No
(Please indicate someone other than the owner)
Cellular Fax
Home Work
Home Work Cellular Fax
Home Work Cellular Fax
Cellular Fax
Home Work
EPIRB Manufacturer __________________________________
Model No. ________________________________________
Telephone
( )_____________________
Area Code
( )_____________________
Area Code
( )_____________________
Area Code
( )_____________________
Area Code
Radio Equipment
VHF MF
Vessel Telephone Numbers
Radio Call Sign ___________ INMARSAT _____________
Cellular ________________ MMSI Number ____________
Federal or State Registration Number ________________
Length Overall (ft) ____________Capacity _____________
Homeport ________________________________________
________________________ ________________________
City
Additional Data ___________________________________
_________________________________________________
Name of Alternate 24-Hour Emergency Contact:
________________________________________________
Telephone
( )_____________________
Other
Area Code
( )_____________________
Other
Area Code
( )_____________________
Other
Area Code
( )_____________________
Other
Area Code
Date ____________________________________________
Fax No. 301-568-8649
Home Work Cellular
Cellular
Home Work
Cellular
Home Work
Home Work Cellular
(Check all that apply)
HF SSB Other __________________
Crew and Passengers
Marina/Dock
State
Home Work
Home Work
Home Work
Home Work
OMB 0648-0295/exp. 30 Nov. 2004
A1-20-0947 Rev. F
Fax Other
Fax Other
Fax Other
Fax Other
Cellular Fax Other
Cellular Fax Other
Cellular Fax Other
Cellular Fax Other