Name of Primary Boater:  __________________________________________________

Description of Boat

Make:

Model:

Length:

Color:

Registration.  Number: _________________ 

Description of Motor

Make:

H.P.

Fuel Capacity:

(gallons)

Other Info.

Occupants Aboard

Name

Address

Tel. No.

Survival Equipment: (Check as Appropriate)

Lifejackets:

Flares:

Mirror:

Flashlight:

Food:

Anchor:

GPS Unit:

Other:

Communication Equipment:

Radio Type:

Frequencies:

Cell Phone Number:

Trip Expectations:

Depart from

 at

(date & time)

Going to

Expect to return by ___________________________________ 

(date & time)

In No Event Later Than ________________________________

(date & time)

Any Other Pertinent Information:_____________________________________________

_______________________________________________________________

Towing Vehicle:

License No.

Year: __________  Make: _______________  Model: _______________

Color:

Parked at:

Other Info:

If not returned by ___________________ (Date & Time ), call the following person(s):

Emergency personnel:

911