ACR Electronics ELT, NOAA Manual

Save Time! Register your beacon online at: www.beaconregistration.noaa.gov
Mail or Fax to: NOAA/SARSAT E/SP3, Room 3320, FB-4, 5200 Auth Road, Suitland, MD 20746-4304
ELT Information
ELT Manufacturer ________________________________ Model No. ___________________________________________
ELT Registration
New ELT Registration
Renewal of ELT Registration
Change of ELT Information or Ownership
Owner/Operator Information
Name______________________________________________
Mailing Address______________________________________
___________________________________________________
City _____________________ State/Province _____________
ZIP (Postal) Code __________ Country ___________________
Aircraft Information
Registration (Tail) Number__________________________
Usage
Commercial Non-
Government Military
Type
Single-engine Propeller
Multi-engine Jet Helicopter
Aircraft Manufacturer ______________________________
Model ___________________Color __________________
Seating Capacity _________________________________
Radio Equipment
(Check all that apply)
VHF MF HF
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 ELT 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
Official 406 MHz ELT Registration Form
Beacon ID (Unique Identifier Number)
(15 digit character ID provided by ELT manufacturer)
Replacement of ELT Decal
Check here if this ELT is a replacement for a previously registered ELT.
Please enter the old ELT unique ID number ______________________
(Last, First, Middle Initial)
commercial
Government Non-military
Single-engine Jet Multi-engine Propeller
Other _________________________
SSB Other ___________________
(Please indicate someone other than the owner)
Home Work Cellular
Home Work Cellular
Cellular
Home Work
Cellular
Home Work
E-mail ___________________________________________
Telephone
( )_____________________
Area Code
( )_____________________
Area Code
( )_____________________
Area Code
( )_____________________
Area Code
Survival Equipment
Deployable _____________________________________
Fixed __________________________________________
Principal Airport _________________________________
________________________ ________________________
Additional Data ___________________________________
________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
Name of Alternate 24-Hour Emergency Contact:
________________________________________________
Telephone
( )_____________________
Fax Other
Area Code
( )_____________________
Fax Other
Area Code
( )_____________________
Fax Other
Area Code
( )_____________________
Fax Other
Area Code
Date ____________________________________________
Fax No. 301-568-8649
Home Work
Home Work
Home Work
Home Work
Describe and List Quantity
Describe and List Quantity
City
Home Work
Home Work
Home Work
Home Work
OMB 0648-0295/exp. 30 Nov. 2004
Cellular Fax Other
Cellular Fax Other
Cellular Fax Other
Cellular Fax Other
State
Cellular Fax Other
Cellular Fax Other
Cellular Fax Other
Cellular Fax Other
A1-20-1180 Rev. A