Form DS-4131 Advance Notification Form: Tourist and Other Non-Governm

U.S. Department of State

ADVANCE NOTIFICATION FORM

OMB APPROVAL NO. 1405-xxxx
EXPIRES: xx/xx/xxxx
ESTIMATED BURDEN: 10.5 HOURS

TOURIST AND OTHER NON-GOVERNMENTAL ACTIVITIES IN THE ANTARCTIC TREATY AREA
This information is requested in furtherance of U.S. obligations under Article VII(5)(a) of the Antarctic Treaty of 1959, and consistent
with Antarctic Treaty Consultative Meeting Recommendation XVIII-1 and Resolution XIX-3. Information below should be submitted no
later than four months prior to intended travel to the Antarctic Treaty Area. Responses will facilitate a determination of U.S. jurisdiction
over the activity and permit timely dissemination to Parties to the Treaty of expedition details. All U.S. nationals organizing expeditions
to Antarctica in the United States, or proceeding to Antarctica from the United States, should submit this form to the U.S. Department
of State as indicated below. For the purposes of this form, "expeditions to Antarctica" include activities south of Sixty degrees South
Latitude, excluding commercial fishing voyages.
Submit completed form to: Antarctic Advisor, Office of Oceans Affairs Room 2665, Bureau of Oceans, Environment and Science,
U.S. Department of State, 2201 C Street NW, Washington DC 20520
NOTE: For purposes of this form, crew includes a vessel's captain and officers, helicopter pilots, and deck, engine, and hotel/catering
staff. Expedition personnel include guides, lecturers, and small boat drivers who are not otherwise counted as crew. Passengers
include others accompanying the expedition, but exclude national representatives or observers.
Include attachments for responses that require more space than the form provides.
A. Expedition Organizer
1. Name of Expedition Organizer (Company, entity, or person(s) as appropriate)

2. Expedition Organizer's Contact Person

3. Mailing Address (Please also provide physical address if using a Post Office Box)

4. Nationality of Organizer

5. Principal Place of Business

6. Total Number of Expedition Staff

7. International Phone

8. International Fax

9. Explain activities undertaken by the organizer, including, for example, acquiring the use of vessels or aircraft, hiring expedition staff, or planning
itineraries.

10. Explain if the organizer maintains substantial ties to a country or countries other than the United States; for example, a U.S. national who habitually
resides in another country, or a company which is the subsidiary of an entity incorporated in or with other substantial ties to another country.

11. Explain whether any organizing activities will be or are being performed by a party or parties other than the named expedition organizer. Identify the
nationality of individuals or commercial entities to whom the expedition organizer has delegated specified organizational responsibilities.

12. Describe where the organizing activities will be or are being performed.

13. Describe where the expedition will proceed from.

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B. Details of Transport and Equipment to be Used for the Tour/Expedition
Complete these panels only once if all Tours/Expeditions planned do not vary in their use of transport or equipment; where these
vary, complete the panel for every Tour or Expedition.
B1. Vessel Aircraft Used for Transport To/From Antarctica
14. Vessel/Aircraft Registered Name

15. Vessel/Aircraft Type

16. National Registration

19. (Check one)
Ship

Yacht

Aircraft

17. Vessel/Aircraft Passenger Carrying Capacity

18. Vessel Ice Rating (If applicable)

20. Vessel/Aircraft Fuel Capacity

21. Vessel/Aircraft Fuel Type

Other

22. Intended Use of Vessel/Aircraft

23. Vessel/Aircraft Call Sign

24. Radio Frequency

25. INMARSAT Number/Fax

26. Captains'/Commanders' Name(s)

27. Total Number of Crew

B2. Equipment to be Used Within Antarctica
28. Number and Types of Aircraft to be Used
Number

Type

Use

29. Number and Types of Other Vessels or Vehicles to be Used (e.g. small boats, snowmobiles)
Number

Type

Use

C. Contingency Planning
30. Type and Amount of Insurance Coverage, Including Name(s) of Insurer(s)

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31. Arrangements for for self-sufficiency and contingency plans including for medical evacuations and search and rescue in the event of an emergency.

D. Expedition Details
32. Planned Port of Embarkation

33. Planned Date of Embarkation (mm-dd-yyyy)

34. Planned Port of Disembarkation

35. Planned Date of Disembarkation (mm-dd-yyyy)

36. Planned Cruise/Flight Number or Voyage Name

37. Estimated Number of Passengers to be Carried

38. Activities to be Undertaken and Purpose

39. Proposed itinerary with dates and places to be visited. Include a proposed itinerary for all expeditions that will proceed south of 60 degrees South
Latitude, even if there is no intention for individuals to disembark onto land.

Certification

Signature of Tour/Expedition Organizer

Date (mm-dd-yyyy)

Public reporting burden for this collection of information is estimated to average 10.5 hours per response, including time required for searching
existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection.
You do not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the accuracy
of this burden estimate and/or recommendations for reducing it, please send them to: U.S. Department of State, A/ISS/DIR, 1800 G St. NW,
Washington, DC 20520.
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