ACR Electronics 406 epirb, noaa Manuel D’Utilisation
Telephone
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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 ______________________________________________
___________________________________________________
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)
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:
Power:
Fishing Tug Cargo
Tanker Pleasure Craft
Other ____________________
Non-power:
Life Boat Life Raft Other__________________
Vessel Name _____________________________________
Vessel Color______________________________________
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 ____________
Cellular ________________ MMSI Number ____________
Federal or State Registration Number ________________
Length Overall (ft) ____________Capacity _____________
Homeport ________________________________________
________________________ ________________________
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. ________________________________________
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