PLEASE PRINT LEGIBLY USING DARK INK WHEN ORDERING
VESSEL SAFETY CHECK  AND AWW/MARITIME DOMAIN AWARENESS MATERIALS ORDER FORM

NAME:	(MSO)	USCG AUXILIARY NATIONAL SUPPLY CENTER	
	(DCDR)	1301 FIRST STREET  SUITE E	
 		(SO-MA)	RIVER’S EDGE	
	(FC)	GRANITE CITY  IL  62040-1803	
ADDRESS:	(FSO-MA)	FAX#: (618) 452-4249	

(		)(		)(		)(		)  DATE:	/	/ (CITY)	(STATE)   (ZIP CODE)	DIST	DIV		FLO		ID NUMBER		(MM)	 (DD)   (YR)

SIGNATURE:  	TITLE:  	

(ANSC USE ONLY: 	PKG PACKED BY:  	)	PK1  	#; PK2  	#; PK3  	#;

NOTE:  WE RESERVE THE RIGHT TO REDUCE QUANTITY DUE TO EXCESSIVENESS OR STOCK AVAILABILITY.

STOCK	DESCRIPTION	MAX NO.		ORD	QTY	QTY ORDERED  SHIPPED	
9012	DECAL, VESSEL SAFETY CHECK - Awarded to boaters upon completion of Vessel
Safety Check Requirements. *INITIAL ALLOCATION: … or BACKUP ALLOCATION: …		
7012	FORM, VESSEL SAFETY CHECK  (VSC) EXAMINATION RECORD - A check list to be
completed by the Auxiliarist and given to the Recreational Vessel Owner		
7012A    FORM, Kayak VESSEL SAFETY CHECK (VSC) EXAMINATION RECORD - A check list
               to be completed by the Auxiliaryist and given to the SUB owner
completed by the Auxiliarist and given to the Recreational Vessel Owner		
7038	FORM, ACTIVITY REPORT VESSEL EXAMINATION - For Auxiliary use to record
VSC, CVF, and UPV information on exams given.	50		
3001	PAMPHLET, WATERFOWL HUNTING TIPS (YIC) - A four-fold pamphlet that provides
ten tips from Wade Bourne on hunting waterfowl effectively and safely.  Safety topics
covered are life jacket, survival kit, boat loading, and to let someone know.	50		
3003	PAMPHLET, YOU’RE IN COMMAND BOAT RESPONSIBLY - Covers topics, such as
Always Wear Your Life Jacket, Never Boat Under the Influence, Take a Boating
Safety Course, Get a Vessel Safety Check, and Carbon Monoxide Can Harm You.	50		
3003-1   PAMPHLET, BOAT RESPONSIBLY! LIVE RESPONSIBLY! (YIC) - A 3 fold brochure that provides tips on living responsibly means boating safely, facts you should know
before boating, responsible boating, never boat under the influence.	50		
3005	PAMPHLET, CARBON MONOXIDE POISONING (YIC) - What you can't see
can harm you.  What is Carbon Monoxide? How you can protect others and yourself.	100		
3006	PAMPHLET, FEDERAL REQUIREMENTS & SAFETY TIPS (YIC) - Contains information
about Federal boating laws, equipment requirements, and safety recommendations.	200		
3009	PAMPHLET, GLOBAL MARITIME DISTRESS & SAFETY SYSTEM (GMDSS) -
Descriptions of system functions, equipment, and capabilities.	50		
3020	DECAL -VHF -EMERGENCY RADIO CALL PROCEDURES (3½” x 5”) CHANNEL 16 -
Have all persons put on life jackets.	100		
3022	PAMPHLET - US AIDS TO NAVIGATION SYSTEM - This 14 page pamphlet is designed
to help the recreational boater better understand the principle use and identification of
the U.S. Aids To Navigation Systems.	100		
3023	PAMPHLET, JOIN THE COAST GUARD AUXILIARY - “SERVICE ON LAND,
SEA, AND IN THE AIR - Membership recruiting	100		
3024	PAMPHLET, SAVED BY THE SIGNAL (VISUAL DISTRESS) - A four-page pamphlet
that summarizes Coast Guard Visual Distress Signal (VDS) requirements, a safety
check list, the types of VDS and a true story: “A flare for Rescue”.	50		
3026	PAMPHLET, WATERWAY WATCH (AWW) - A quick overview of America’s
Waterway Watch.  Provides examples of suspicious activities.  Also includes a sample form for reporting suspicious activities, along with important phone #’s.
… English   … Spanish	(Please specify)	100		
3026a	DECAL, WATERWAY WATCH (AWW) - For placement on window or windshield
of your vessel or place of business. (3½” x 3½”)	100		
3026a1  DECAL, WATERWAY WATCH (AWW) - 2 Sided with AWW info on one side.  For
placement on window or windshield of your vessel or place of business. (5 ¾ x 4”)	100		
3026b	WALLET CARD, WATERWAY WATCH (AWW) - Handy informative card that
slips easily into your wallet or shirt pocket.  Provides list of suspicious activities
and phone numbers to call if you witness such activities. (2” x 3½”)	100		
3026c	POSTER, WATERWAY WATCH (AWW) - Attractive, colorful poster introducing
America’s Waterway Watch.  Provides National Response Center’s Terrorist
Hotline number.  (22” x 34”)	5		
		
SEE REVERSE SIDE FOR ADDITIONAL INFORMATION	(REV. 12/2008)

STOCK	DESCRIPTION	MAX	QTY	QTY NO.		ORD  ORDERED  SHIPPED
“AMERICA’S  WATERWAY WATCH - MARITIME DOMAIN AWARENESS”

3026c1  POSTER, WATERWAY WATCH (AWW) - Report Suspicious Activity on the Waterfront
Call 911 or 800-424-8802 or 877-24WATCH  www.AmericasWaterwayWatch.org
LAMINATED FOR OUTDOOR USE.  (11” x 14”)	… Marina
… New York - Statue Of Liberty  … Seattle - Skyline looking Toward Water
… Hawaii-Inner Harbor and Bell Tower   … Boston - Sky Line and Nathaniel Hall
… Pittsburg - 3 Rivers and Yellow Bridges   … Container Ship Yard
… San Francisco - San Fran Belle and Schooner   … Cruise Ships
… Nashville - MV General Jackson and Sky line   … Baltimore Harbor
(Please specify which poster or check appropiate box)	5
3028	PAMPHLET, CHILDREN & PERSONAL WATERCRAFT - Provides a quick summary
of what you must know to be safe on the water.	50
3029	PAMPHLET, PADDLE SAFE -HAVE FUN (BR) - A 4-fold pamphlet that provides ten tips on how to paddle safely.  Features 2004 Olympic Silver Medal winner
for Whitewater Kayaking, Rebecca Giddens.  Safety topics covered include always
wear a life jacket, don't drink while paddling, stay low in your boat to prevent capsizing, keep your balance, practice the wet exit, dress for weather conditions, plan ahead,
never paddle alone, be in command of your boat, and learn about your boat.	100
3030	PAMPHLET, FISHING TIPS (BR) - A three-fold pamphlet that provides ten tips from Bill Dance on how to fish effectively and safely.  Safety topics covered are always wear a life jacket, boat safe and sober, and get schooled on boating
safety.  Pamphlet also provides tips on how to catch more fish.	100
3031	PAMPHLET, SAFE BOATING TIPS FOR ANGLERS, HUNTERS & CAMPERS -This
16 page booklet covers fourteen individual recreational boating safety topics ranging from Tips for Anglers, Hunters & Campers, Life Jackets - Wear them, Sobering Facts about Alcohol, Hypothermia – The Cold Killer, What You Must Have Aboard, Distress Signals, Carbon Monoxide Poisoning, First Aid Emergency Measures,  U.S. Aids to Navigations, Charts - Your Nautical Road Maps, Boating’s Operating Rules, Canoeing/Kayaking Safety, Keep Our Waters
Clean and Take A Boating Course.	100
3032	PAMPHLET, HOW TO CHOOSE THE RIGHT LIFE JACKET - An informative guide that provides specifications and photos of 13 different types of life jackets, how they perform, and for what activities they are best suited. Also features tips on
how to check if a jacket fits properly.	50
3033	PAMPHLET, BEWARE OF BOAT PROPELLERS - Provides safety tips and
examples of various devices that can be used to prevent strikes.	50
3039	PAMPHLET, "5 TONS AND NO BRAKES" - Suggestions for Houseboating safety.	100
3504	POSTER, VESSEL SAFETY CHECK EVENT - Shows decal and person to contact for a
free Vessel Safety Check.  (Used primarily for PROMOTION/EVENTS)   (8½” x 11”)	2
4036	PHLT, "ENVIRONMENTAL GUIDE FOR PERSONAL WATERCRAFT OPERATORS"
Gives PWC operators tips to be environmentally friendly.	50
4038	PAMPHLET, HELP US PROTECT THE MARINE ENVIRONMENT … Eng  … Sp  … Fr   100
4044	PAMPHLET, “HOW’S THE WATER?”	… English	… Spanish -Contains a chart
of restrictions on what can be dumped in the water and a citizen report form
for pollution incidents.	100
4045	PAMPHLET, CLEANER BOATING ENVIRONMENT	… English	… Spanish	100
4063	STICKER, "REPORT MARINE POLLUTION" (3” x 6”) - A (800) number to call to report marine pollution on Oil Spills, Chemical Spills or Illegal Dumping.	50
4064	STICKER, DISCHARGE OF OIL PROHIBITED FWPCA (5” x 8”) - Information on
discharge of oil or oily waste into or upon the navigable.	50
4078	STICKER, "WE CARE - PLEASE DO NOT LITTER OVERBOARD"	50
9017	CARD, VESSEL SAFETY CHECK - Card given to boaters with fill in information
of whom to contact for the Vessel Safety Check and Decals. (3” x 5”)	50
9025	PLASTIC BAG, (BR) - A 12" x 18" - The bag displays "BOAT RESPONSIBLY" - Always wear your Life Jacket - Never boat under the influence - Take a boating safety course Get a free Vessel Safety Check.  Ideal for use at boat shows, conferences and other
venues to facilitate the distribution of boating safety and other promotional materials.	25

"JUSTIFICATION" (WHERE QUANTITY EXCEEDS MAX PER FIGURE)
*** SHIP TO: (If other than listed above)

(REV. 12/2008)