Personal Location Beacon / EPIRB No Date of Hire Date of Return Which company is transferring you to the island Your Full Name Date of Birth Address State Postcode Email Home Phone Mobile Phone Number of people in your party Are you carrying a satellite phone? Yes No Licence or Passport No. Emergency contact in case of an Activation Name Phone Number Address State Postcode Donation $15 $20 Other Please deduct this donation from credit card details below Yes, please deduct WARNING: Each PLB/EPIRB is individually coded and registered. In the event of the PLB/EPIRB being Lost, Stolen, Damaged or Activated under a non life-threatening situation, I hereby agree to pay the replacement cost of $350.00 which can be deducted from my Credit Card: Name on Card Credit Card No. Expiry CVV Donations go towards Great Green Way Tourism Incorporated (a not for profit organisation) for the purchase & maintenance of beacons. Send
