Emergency Position Indication Radiobeacon

Save Time! Register your beacon online at: www.beaconregistration.noaa.gov

Mail or Fax to:

Official 406 MHz EPIRB Registration Form

Fax No. 301-817-4565

EPIRB Information

NOAA/SARSAT
NSOF, E/SP3
4231 Suitland Road
Suitland, MD 20746

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 Information
Registration
EPIRB
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 ______________________________________

(

)_____________________

Area Code

Home

Work

Cellular

Fax

Other

(

)_____________________

Home

Work

Cellular

Fax

Other

(

)_____________________

Home

Work

Cellular

Fax

Other

ZIP (Postal) Code __________ Country ___________________ (

)_____________________

Home

Work

Cellular

Fax

Other

___________________________________________________
City _____________________ State/Province _____________

Area Code
Area Code
Area Code

E-mail ______________________________________________

Vessel Information
Usage:

Commercial
Government Military

Radio Equipment (Check all that apply)

Non-commercial
Government Non-military

VHF

Type
Sail: Number of Masts ____________________
Power:

Fishing

Tug

Cargo

Tanker

Life Boat

Life Raft

HF

SSB

Other ___________________

Radio Call Sign ______________ INMARSAT _____________________

Pleasure Craft

Other ____________________

Non-power:

MF

Vessel Telephone Numbers
Cellular ____________________ MMSI Number ___________________

Federal / State Registration Number __________________
Other__________________

Vessel Name _____________________________________
Vessel Color____________

Length Overall (ft) ____________Capacity _____________
Crew and Passengers

Homeport ________________________________________
Marina/Dock

Survival Craft(s) on Vessel: Life Boat _____ Life Raft _____
No. of

No. of

Is your EPIRB equipped with a Simplified Voyage
Data Recorder (SVDR)?
Yes
No

________________________ ________________________
City

State

Additional Data ___________________________________
_________________________________________________

Emergency Contact Information (Please indicate someone other than the owner)
Name of Primary 24-Hour Emergency Contact:
__________________________________________________

Name of Alternate 24-Hour Emergency Contact:
________________________________________________

Telephone

Telephone

(

)_____________________

Home

Work

Cellular

Fax

Other

(

)_____________________

Home

Work

Cellular

Fax

Other

(

)_____________________

Home

Work

Cellular

Fax

Other

(

)_____________________

Home

Work

Cellular

Fax

Other

Area Code
Area Code
Area Code
Area Code

Signature __________________________________________

(

)_____________________

Home

Work

Cellular

Fax

Other

(

)_____________________

Home

Work

Cellular

Fax

Other

(

)_____________________

Home

Work

Cellular

Fax

Other

(

)_____________________

Home

Work

Cellular

Fax

Other

Area Code
Area Code
Area Code
Area Code

Date ____________________________________________

If you have any questions about this form or with EPIRB registration in general, please call 1-888-212-SAVE (7283) or 301-817-4515.
For information on the U.S. Search & Rescue Satellite-Aided Tracking system, please visit: www.sarsat.noaa.gov

OMB Auth. (0648-0295) Expires: 31JAN2008

Important Notice - Please Read Before Completing Registration
Registration is an important facet for all Cospas-Sarsat 406 MHz emergency beacons. Not only is it required by Federal
Regulations but the information you furnish is used by Search And Rescue (SAR) agencies in the event of beacon
activation. The registration information is an important tool to assist the United States Coast Guard, United States Air
Force, and other SAR agencies in locating and quickly responding to you, your vessel, or your aircraft. Failure to register
your beacon may delay a rescue response. Accurate, up-to-date registration information will also be used to conserve
resources by helping to eliminate false alert deployments, as an inadvertent activation can be resolved with a phone call.
There is no charge for beacon registration. This is a service provided by the U.S. National Oceanic and
Atmospheric Administration (NOAA).
All online registrations will be entered into the National 406 MHz Beacon Registration Database on the same day of entry.
Registration forms received via postal mail will be entered within 2 business days of receipt. For online registrations, a
confirmation letter with your completed registration information form will be sent immediately via e-mail or fax (if provided).
Confirmation letters sent via postal mail should arrive 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
301-817-4515 for assistance.
After initial registration (or re-registration) you will receive a NOAA Proof of Registration Decal by postal mail. This decal is
to be affixed to the beacon and should be placed in such a way that it is clearly visible. 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 301-817-4515.
Failure to register, re-register (as required every two years), or to notify NOAA of any changes to the status of your
406 MHz beacon could result in penalties and/or fines being issued under Federal Law. The owner or user of the beacon is
required to notify NOAA of any changes to the registration information at any time. By submitting this registration the owner,
operator, or legally authorized agent declares under penalty of law that all information in the registration information is true,
accurate, and complete. Providing information that is knowingly false or inaccurate may be punishable under Federal
Statutes. Solicitation of this information is authorized by Title 47 - Parts 80, 87, and 95 of the U.S. Code of Federal
Regulations (CFR). Additional registration forms can be found on the NOAA-SARSAT website at: www.sarsat.noaa.gov or
at: www.beaconregistration.noaa.gov.
Please note, NOAA will complement or update your registration information accordingly if your registration has expired
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 an expired beacon registration. Although the information provided will
become a matter of public record, there is no intent to circulate beyond its intended purpose, i.e., to assist SAR agencies in
carrying out their mission. 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, and completing and reviewing
the collection of information. Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any
person be subjected to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork
Reduction Act, unless that collection of information displays a currently valid OMB Control Number. Comments regarding this
burden or any other aspect of this collection of information, including suggestions for reducing this burden should be sent to:
NOAA/SARSAT
NSOF, E/SP3
4231 Suitland Road
Suitland, MD 20746
Or call: 1-888-212-SAVE (7283) or 301-817-4515
Finally, false alerts remain a chief concern for SAR agencies. We ask that you carefully refer to the beacon’s user manual
for instructions on properly operating, installing, testing, performing required maintenance, and/or stowage of your beacon.
We find that these are important factors in reducing the number of false alerts. Please use the utmost care at all times!