To receive your MMSI INSTANTLY, complete this form directly online!

You will receive your MMSI confirmtaion upon completion of the 
registration. We recommend noting your MMSI in the radio owner's
manual.  If you are unable to complete the form online, please 
complete the form below and return it via fax, regular mail or email
to mmsi@boatus.com -You can expect to recieve your MMSI number within
4-10 days of receipt.

			 
The BoatU.S. MMSI Program has been certified by both the Federal 
Communications Commission and the U.S. Coast Guard to assign MMSI 
numbers to vessels with DSC capable radios that are not required 
by law to carry a radio, and do not make international voyages or 
communications.  


IMPORTANT NOTE:  
Your MMSI# may only be able to be entered twice during the initial
set up process. If you try to program your radio more than twice 
with the assigned MMSI#, the radio may have to be sent back to the 
manufacturer. Please be careful when initially entering your newly 
assigned MMSI number.


INSTRUCTIONS:
1. Complete the MMSI Assignment Form on the next page.  
2. Note the required fields as indicated by an(*).  These fields
   must be completed in order to receive an MMSI number.
3. Refer to the Ship Classification table when completing the 
   Ship Classification question.
4. Return the Assignment Form (next page) to:
   		
		BoatU.S. MMSI Program  
		880 S. Pickett St.
		Alexandria, VA 22304.
			    OR 
		Fax to: BoatU.S. MMSI Program
		        703-461-2840 
		MMSI Info Line: (800) 563-1536

*The MMSI ASSIGNMENT FORM may be found on the next page (scroll 
down to view on the web browser).




















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			MMSI ASSIGNMENT FORM

*Denotes a required field.  These fields must be completed to receive an MMSI#.
------------------------------------------------------------------------------------

*OWNER'S FIRST NAME:________________________________________________________________

*OWNER'S LAST NAME:_________________________________________________________________

   OR PROVIDE COMPANY NAME:_________________________________________________________

* STREET ADDRESS:___________________________________________________________________

* CITY:__________________________________________________  * STATE:_________________

* ZIP CODE:__________  PROVINCE, MAIL CODE, COUNTRY: _______________________________

*OWNER'S HOME PHONE:___________________  OWNER'S ALTERNATE PHONE:_________________

EMAIL ADDRESS:______________________________________________________________________
	      (Confirmation will be sent to email address, if provided)

*NAME OF PRIMARY EMERGENCY CONTACT ASHORE:__________________________________________

*PRIMARY CONTACT HOME PHONE:________________________________________________________

PRIMARY CONTACT ALTERNATE PHONE:____________________________________________________



NAME OF ALTERNATE CONTACT ASHORE:___________________________________________________

ALTERNATE CONTACT HOME PHONE:_______________________________________________________

ALTERNATE CONTACT ALTERNATE PHONE:__________________________________________________

BOAT U.S. MEMBER (If Applicable) #:_________________________________________________

*RADIO TYPE: 
		____ FIXED MOUNT VHF W/DSC
		____ AIS
		____ HANDHELD VHF W/DSC
		____ PORTABLE DIVING VHF W/DSC
		N/A_ MED/HIGH FREQUENCY W/DSC  (Requires FCC Ship Station License)
		N/A_ SINGLE SIDEBAND W/DSC     (Requires FCC Ship Station License)

VESSEL NAME:________________________________________________________________________

RADIO CALL SIGN:______________________

VESSEL WIRELESS PHONE 1:_____________________ WIRELESS 2:___________________________

VESSEL WIRELESS PHONE 3:_____________________ WIRELESS 4:___________________________


VESSEL FLAG STATE(Usually USA):_____________________________________________________

*SHIP CLASSIFICATION (SEE TABLE BELOW):_____________________________________________

EX-SHIP NAME (IF KNOWN):____________________________________________________________  

EX-CALL SIGN (IF KNOWN):__________________ EPIRB ID CODE:___________________________

*VESSEL STATE REGISTRATION NUMBER:______________________________________________
		OR
*USCG DOCUMENTATION NUMBER:______________________________________________

*VESSEL HOME PORT:(Marina Name or Residence)________________________________________

PORT CITY:_____________________________________  PORT STATE:________________________

ALTERNATE VESSEL HOME PORT:_________________________________________________________

*CAPACITY (HIGHEST # OF PERSONS EXPECTED TO BE ON BOARD):___________________________   

*REMARKS 
(Describe boat length, type, color etc, and anything the USCG should be aware of in 
a distress. For Dive radio, describe how and where portable unit is to be used.)

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________



*See SHIP CLASSIFICATION TABLE below (scroll down to view on the web browser).









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		*SHIP CLASSIFICATION TABLE

DUN - KETCH                     MTB - MOTOR BOAT
SLO - SLOOP                     YAT - YACHT
GOL - SCHOONER                  VLR - SAILING SHIP
SAE - RESCUE VESSEL             XXX - UNSPECIFIED

*Note: Please be sure to describe the vessel in the remarks section!