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 Fax No. 301-568-8649 EPIRB Information Beacon ID (Unique Identifier Number) (15 digit character ID provided by EPIRB manufacturer) Category I (Automatic Deployment) Category II (Manual Deployment) EPIRB Manufacturer __________________________________ Model No. ________________________________________ EPIRB Registration New EPIRB Registration Renewal of EPIRB Registration Change of EPIRB Information or Ownership 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 ________________________ Owner/Operator Information Name______________________________________________ Telephone (Last, First, Middle Initial) Mailing Address ______________________________________ ___________________________________________________ City _____________________ State/Province _____________ E-mail ______________________________________________ Area Code Area Code Area Code Area Code ( ( ( )_____________________ )_____________________ )_____________________ )_____________________ Home Home Home Home Work Work Work Work Cellular Cellular Cellular Cellular Fax Fax Fax Fax Other Other Other Other ZIP (Postal) Code __________ Country ___________________ ( Vessel Information Usage Commercial Government Military Non-commercial Government Non-military Radio Equipment (Check all that apply) VHF MF HF SSB Other __________________ Type Sail: Number of Masts ____________________ Power: Fishing Tug Cargo Life Raft Tan ker Pleasure Craft Other ____________________ Vessel Telephone Numbers Radio Call Sign ___________ INMARSAT _____________ Cellular ________________ MMSI Number ____________ Federal or State Registration Number ________________ Length Overall (ft) ____________Capacity _____________ Homeport ________________________________________ ________________________ ________________________ City State Marina/Dock Crew and Passengers Non-power: Life Boat Other__________________ Vessel Name _____________________________________ Vessel Color______________________________________ Survival Craft(s) on Vessel Life Boat ____________________ Life Raft ____________________ Is your EPIRB equipped with a Simplified Voyage Yes No Data Recorder (SVDR)? No. of No. of Additional Data ___________________________________ _________________________________________________ Emergency Contact Information (Please indicate someone other than the owner) Name of Primary 24-Hour Emergency Contact: __________________________________________________ Telephone Area Code Area Code Area Code Area Code Name of Alternate 24-Hour Emergency Contact: ________________________________________________ Telephone ( ( ( ( )_____________________ )_____________________ )_____________________ )_____________________ ( ( ( ( )_____________________ )_____________________ )_____________________ )_____________________ Home Home Home Home Work Work Work Work Cellular Cellular Cellular Cellular Fax Fax Fax Fax Other Other Other Other Area Code Area Code Area Code Area Code Home Home Home Home Work Work Work Work Cellular Cellular Cellular Cellular Fax Fax Fax Fax Other Other Other Other Signature __________________________________________ Date ____________________________________________ OMB 0648-0295/exp. 30 Nov. 2004 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 A1-20-0947 Rev. F Important Notice - Please Read Before Completing Registration The information you furnish is mandatory and is intended to assist search and rescue teams in locating you or your craft in the event of beacon activation. The information will be provided to the United States Coast Guard, United States Air Force, and other Search and Rescue (SAR) teams as appropriate in the event of beacon activation. It will also be used to conserve SAR resources by helping to eliminate false alert deployments, as an inadvertent activation can be resolved with a phone call. Failure to register, re-register, or to notify NOAA of a change in the status for a 406 MHz beacon could result in penalties and/or fines being issued to the owner. An owner is required to notify NOAA of any changes to the registration information. Please note, NOAA will complement or update the datebase accordingly when a beacon owner's registration expires and credible information is provided from SAR sources. NOAA will also seek information from other databases to update and/or complement the existing information for a beacon registration. Solicitation of this information is authorized by Parts 80 and 87, Title 47 of the Code of Federal Regulations (CFR). There is no charge for beacon registration. This is a service provided by the U.S. Government. All online registrations will be entered into the National 406 MHz Beacon Registration Database on the same day of entry. Registration forms received via the postal mail service will be entered into the National 406 MHz Beacon Registration Database within 2 business days of receipt. For online registrations, a letter with an attached registration information sheet will be sent immediately via e-mail or fax (if provided), or via postal mail within two weeks. Once your registration confirmation is received, please review all information. Any changes or updates to your registration information can be done via the internet, fax, e-mail or postal mail. If you do not receive your registration confirmation from NOAA on the same day you submit it over the internet or within two weeks if you submit it by postal mail, please call NOAA toll-free at: 1-888-212-SAVE (7283) or 301-457-5678 for assistance. After initial registration (or re-registration) you will receive a NOAA Proof of Registration Decal by postal mail. It is required that you affix the registration decal to your beacon. If for some reason you do not receive the registration decal within two weeks, please call NOAA toll-free at: 1-888-212-SAVE (7283) or 301-457-5678, for assistance. Additional registration forms can be found on the NOAA SARSAT website at: www.sarsat.noaa.gov or at: www.beaconregistration.noaa.gov. Although the information provided will become a matter of public record, there is no intent to circulate the data furnished beyond its intended purpose, i.e., to assist SAR forces in carrying out their mission of rescue assistance and false alert abatement. Public reporting burden for the collection of this information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden should be sent to: NOAA/SARSAT E/SP3, FB4, Room 3320 5200 Auth Rd Suitland, MD 20746-4306 Or call: 1-888-212-SAVE (7283) or 301-457-5678 ...