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ACR Electronics 406 epirb, noaa User Manual

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Telephone
(
)_____________________
(
)_____________________
(
)_____________________
(
)_____________________
Area Code
Area Code
Area Code
Area Code
Home
Work
Cellular
Fax
Other
Home
Work
Cellular
Fax
Other
Home
Work
Cellular
Fax
Other
Home
Work
Cellular
Fax
Other
Telephone
(
)_____________________
(
)_____________________
(
)_____________________
(
)_____________________
Area Code
Area Code
Area Code
Area Code
Home
Work
Cellular
Fax
Other
Home
Work
Cellular
Fax
Other
Home
Work
Cellular
Fax
Other
Home
Work
Cellular
Fax
Other
Telephone
(
)_____________________
(
)_____________________
(
)_____________________
(
)_____________________
Area Code
Area Code
Area Code
Area Code
Home
Work
Cellular
Fax
Other
Home
Work
Cellular
Fax
Other
Home
Work
Cellular
Fax
Other
Home
Work
Cellular
Fax
Other
Owner/Operator Information
Name______________________________________________
Mailing Address ______________________________________
___________________________________________________
City  _____________________ State/Province _____________
ZIP (Postal) Code __________  Country ___________________
E-mail ______________________________________________
(Last, First, Middle Initial)
Official 406 MHz BEACON Registration Form
Category I (Automatic Deployment)
Category II (Manual Deployment)
EPIRB Information
Beacon ID (Unique Identifier Number)
(15 digit character ID provided by EPIRB manufacturer)
Vessel Information
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
OMB 0648-0295/exp. 30 Nov. 2004
EPIRB Registration
New EPIRB Registration
Replacement of EPIRB Decal
Renewal of EPIRB Registration 
Check here if this EPIRB is a replacement for a previously registered EPIRB. 
Change of EPIRB Information or Ownership
Please enter the old EPIRB unique ID number ________________________
Crew and Passengers
Marina/Dock
Usage
Commercial
Non-commercial 
Government Military
Government Non-military
Type
Sail: Number of Masts ____________________
Power:   
Fishing        Tug        Cargo   
Tanker      Pleasure Craft
Other ____________________ 
Non-power:  
Life Boat       Life Raft      Other__________________
Vessel Name _____________________________________ 
Vessel Color______________________________________
Survival Craft(s) on Vessel   
Life Boat ____________________ 
    
 Life
 
Raft ____________________ 
Radio Equipment 
(Check all that apply)
VHF         MF           HF           SSB         Other __________________
Vessel Telephone Numbers
Radio Call Sign ___________ INMARSAT _____________ 
Cellular ________________ MMSI Number ____________
Federal or State Registration Number ________________
Length Overall (ft) ____________Capacity _____________
Homeport ________________________________________
________________________  ________________________
Additional Data ___________________________________
_________________________________________________
No. of
No. of
City
State
Emergency Contact Information
(Please indicate someone other than the owner)
Name of 
Primary 24-Hour Emergency Contact: 
Name of 
Alternate 24-Hour Emergency Contact: 
__________________________________________________
________________________________________________
EPIRB Manufacturer __________________________________
Model No. ________________________________________
Signature __________________________________________ 
Date ____________________________________________
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
Fax No. 301-568-8649
A1-20-0947 Rev. F
Is your EPIRB equipped with a Simplified Voyage
Data Recorder (SVDR)?
Yes
No