Travelers' Century Club® Status Change Application If you have reached a new travel milestone* we want to hear about it! Fill out this form and check off the destinations you have visited on the list below. Then email (preferred) or mail the form to: Travelers' Century Club P.O. Box 2297 or E-mail: [email protected] Cupertino, CA 95015

INSTRUCTIONS: 1. Fill in your name and, if spouse is also moving up and has the same country list, enter spouse's name on the form. 2. Enter any changes to your address, telephone number or e-mail address. 3. One lapel pin matching your new status level is included in your recognition packet. Please indicate in the notes section whether you would like a butterfly clasp or safety pin style backing. 4. Check off all countries visited using the attached country list of TCC countries and territories.

Please allow 6-8 weeks for processing of status change.

This fillable PDF form may be filled out on your computer and printed for submission to the TCC, or you may print the blank form and complete your application by hand.

______Mr./Ms./Mrs./Dr. Given Name(s) Family Name ______Total Destinations Visited: ______Please specify exactly how you want your name to appear on your Certificate (From the List Below) ______Total Destinations Visited: ______Spouse (If Also Moving Up) (Submit Separate List for Spouse) ______Telephone ______Address** ______E-mail ______

Address Line 2 (Optional)

______City State Postal Code Country

Notes:

WHAT HAPPENS AFTER YOU REPORT A STATUS CHANGE? • You will receive a new status level recognition packet, which includes a certificate for your new level and the lapel pin that goes with that level. • You will receive recognition in an upcoming issue of The Centurian in the "Well Traveled" section. • Your new status will also be reflected in the next version of the club membership directory, which is posted in the TCC Forum. Note: If you would like your Chapter Coordinator to present your certificate to you at an upcoming meeting, just let us know and we will mail the certificate and pin to them; otherwise the packet will be mailed to your address that we have on record.

* Travel milestones reflect the number of destinations you have visited based on the list of TCC Countries & Territories included in the checklist below. The status levels are: • Silver — 150 countries • Gold — 200 countries • Platinum — 250 countries • Diamond — 300 countries ** If your country requires an address label in a local character set, please email us that information Name: ______

LIST OF TCC COUNTRIES AND TERRITORIES:

PACIFIC OCEAN (40) ! Austral Islands ! Nauru ! Australia ! New Caledonia & Dependencies ! Bismarck Archipelago (Admiralty Islands, (L'Île-des-Pins, Loyalty Islands) Bougainville, New Britain, New Ireland) ! New Zealand ! Chatham Islands ! Niue ! Cook Islands (Aitutaki, Penrhyn, Rarotonga) ! Norfolk Island ! Easter Island ! Northern Marianas (Saipan, Tinian) ! Fiji Islands ! Ogasawara (Bonin, Iwo Jima, Volcano Island) ! French Polynesia (Gambier, Tahiti, Tuamotu) ! Palau, Republic of ! Galapagos Islands ! Papua New Guinea ! Guam ! Pitcairn Island ! Hawaiian Islands ! Ryukyu Islands (Okinawa) ! Juan Fernandez Islands (Robinson Crusoe Is.) ! Samoa, American ! Kiribati (Gilberts, Ocean Island, Tarawa) ! Samoa ! Line/Phoenix Islands (Canton, Christmas, ! Solomon Islands (Guadalcanal, New Enderbury, Fanning) Georgia, Tulagi) ! Lord Howe Island ! Tasmania ! Marquesas Islands ! Tokelau Islands (Atafu, Fakaofu, Union) ! Marshall Islands, Republic of (Eniwetok, ! Tonga (Nukualofa) Kwajalein, Majuro) ! Tuvalu (Ellice Island, Funafuti, Vaitapu) ! Micronesia, Federated States of (Caroline ! Vanuatu (New Hebrides Islands) Islands, Chuuk, Kosrae, Pohnpei, Yap ) ! Wake Island ! Midway Island ! Wallis & Futuna Islands NORTH AMERICA (6) ! Alaska ! Prince Edward Island ! Canada ! St. Pierre & Miquelon ! Mexico ! United States (Contiguous) CENTRAL AMERICA (7) ! Belize ! Honduras ! Costa Rica ! Nicaragua ! El Salvador ! Panama ! Guatemala SOUTH AMERICA (14) ! Argentina ! Guyana ! Bolivia ! Nueva Esparta (Margarita Island) ! Brazil ! Paraguay ! Chile ! Peru ! Colombia ! Suriname ! Ecuador ! Uruguay ! French Guiana ! Venezuela CARIBBEAN (30) ! Anguilla ! Montserrat ! Antigua & Barbuda ! Puerto Rico ! Aruba ! Saba & Sint Eustatius ! Bahamas ! St. Barthélemy ! Barbados ! St. Kitts & Nevis ! Bonaire ! St. Lucia ! Cayman Islands ! St. Martin (France)

Page 2 Name: ______

CARIBBEAN (CONT.) ! Cuba ! St. Vincent & the Grenadines ! Curacao ! San Andres & Providencia ! Dominica ! Sint Maarten (Netherlands) ! Dominican Republic ! Trinidad & Tobago ! Grenada & Deps. (Carriacou, Grenadines) ! Turks & Caicos Islands ! Guadeloupe & Deps. (Marie Galante) ! Virgin Islands, British ! Haiti (Tortola, etc.) ! Jamaica ! Virgin Islands, U.S. ! Martinique (St. Croix, St. John, St. Thomas) ATLANTIC OCEAN (14) ! Ascension ! Fernando de Noronha ! Azores Islands ! Greenland (Kalaallit Nunaat) ! Bermuda ! Iceland ! Canary Islands ! Madeira ! Cape Verde Islands ! St. Helena ! Falkland Islands ! South Georgia & the South Sandwich Islands ! Faroe Islands ! Tristan da Cunha EUROPE & THE MEDITERRANEAN (68) ! Aland Islands ! Kaliningrad ! Albania ! Kosovo ! Andorra ! Lampedusa ! Austria ! Latvia ! Balearic Islands (Mallorca, Minorca, Ibiza) ! Liechtenstein ! Belarus ! Lithuania ! Belgium ! Luxembourg ! Bosnia & Herzegovina ! Malta ! Bulgaria ! Moldova ! Corsica ! Monaco ! Crete ! Montenegro ! Croatia ! Netherlands ! Cyprus, British Sovereign Base Areas of ! North Macedonia Akrotiri & Dhekelia ! Norway ! Cyprus, Republic ! Poland ! Cyprus, Turkish Federated State ! Portugal ! Czech Republic ! Romania ! Denmark ! Russia ! England ! San Marino ! Estonia ! Sardinia ! Finland ! Scotland ! France ! Serbia ! Germany ! Sicily ! Gibraltar ! Slovakia ! Greece ! Slovenia ! Greek Aegean Islands (Cyclades, ! Spain Dodecanese, Northern Aegean Islands) ! Spitsbergen ! Guernsey & Dependencies (Alderney, (Svalbard, Bear Island) Herm, Sark) ! Srpska ! Hungary ! Sweden ! Ionian Islands (Corfu, etc.) ! Switzerland ! Ireland (Eire) ! Transnistria (Pridnestrovie) ! Ireland, Northern ! Turkey in Europe (Istanbul) ! Isle of Man ! Ukraine

Page 3 Name: ______

EUROPE & THE MEDITERRANEAN (CONT.) ! Italy ! Vatican City ! Jersey ! Wales ANTARCTICA (7) ! Argentine Antarctica (Antarctic Peninsula) ! Chilean Antarctic Territory (Antarctic Peninsula) ! Australian Antarctic Territory (Davis, Heard, ! French Antarctica (Adélie, Kerguelen) Macquarie, Mawson) ! New Zealand Antarctica (Ross Dependency) ! British Antarctic Territory (Antarctic Peninsula, ! Norwegian Dependencies (Bouvet, Peter I Island, Graham Land, South Orkney, South Shetland) Queen Maud Land) AFRICA (55) ! Algeria ! Libya ! Angola ! Malawi ! Benin ! Mali ! Botswana ! Mauritania ! Burkina Faso ! Morocco ! Burundi ! Morocco, Spanish (Ceuta, Melilla) ! Cabinda ! Mozambique ! Cameroon ! Namibia ! Central African Republic ! Niger ! Chad ! Nigeria ! Congo, Democratic Republic of (Kinshasa) ! Rwanda ! Congo, Republic of (Brazzaville) ! Sao Tome & Principe ! Côte d'Ivoire (Ivory Coast) ! Senegal ! Djibouti ! Sierra Leone ! Egypt in Africa ! Somalia (Italian Somaliland) ! Equatorial Guinea (Bioko) ! Somaliland (British) ! Equatorial Guinea (Rio Muni) ! South Africa ! Eritrea ! South Sudan ! Eswatini (Swaziland) ! Sudan ! Ethiopia ! Tanzania ! Gabon ! Togo ! Gambia, The ! Tunisia ! Ghana ! Uganda ! Guinea ! Western Sahara ! Guinea-Bissau ! Zambia ! Kenya ! Zanzibar ! Lesotho ! Zimbabwe ! Liberia MIDDLE EAST (21) ! Abu Dhabi ! Lebanon ! Ajman ! Oman ! Bahrain ! Palestine ! Dubai ! Qatar ! Egypt in Asia (Sinai Peninsula) ! Ras Al Khaimah ! Fujairah ! Saudi Arabia ! Iran ! Sharjah ! Iraq ! Syria ! Israel ! Umm Al Qaiwain ! Jordan ! Yemen ! Kuwait

Page 4 Name: ______

INDIAN OCEAN (15) ! Andaman-Nicobar Islands ! Mauritius & Dependencies ! British Indian Ocean Territory (Agalega, St. Brandon) (Chagos Archipelago, Diego Garcia) ! Mayotte (Dzaoudzi) ! Christmas Island ! Reunion ! Cocos (Keeling) Islands ! Rodrigues Island ! Comoros (Anjouan, Grand Comoro, Moheli) ! Seychelles ! Lakshadweep ! Socotra ! Madagascar ! Zil Elwannyen Sesel ! Maldives (Aldabra, Amirante Islands, Farquhar) ASIA (52) ! Abkhazia ! Maluku Islands ! Afghanistan ! Mongolia, Republic ! Armenia ! Myanmar (Burma) ! Azerbaijan ! Nakhchivan ! Bangladesh ! Nepal ! Bhutan ! Pakistan ! Brunei ! Papua (Irian Jaya) ! Cambodia ! Philippines ! China, People's Republic ! Russia in Asia (including Siberia) ! Georgia ! Sabah (North Borneo) ! Hainan Island ! Sarawak ! Hong Kong ! Sikkim ! India ! Singapore ! Indonesia (Java) ! South Ossetia ! Japan ! Sri Lanka (Ceylon) ! Jeju Island (South Korea) ! Sulawesi (Celebes, Indonesia) ! Kalimantan (Indonesian Borneo) ! Sumatra (Indonesia) ! Kashmir ! Taiwan, R.O.C. ! Kazakhstan ! Tajikistan ! Korea, North ! Thailand ! Korea, South ! Tibet ! Kyrgyzstan ! Timor-Leste ! Laos ! Turkey in Asia (Anatolia, Ankara, Izmir) ! Lesser Sunda Islands (Bali, Timor, Indonesia) ! Turkmenistan ! Macau ! Uzbekistan ! Malaysia ! Vietnam THIS LIST HAS WIDESPREAD RECOGNITION AS THE STANDARD OF COUNTRIES AND TERRITORIES THAT ARE OF SIGNIFICANT INTEREST, AS DISTINCT DESTINATIONS, TO SERIOUS TRAVELERS.

Version: June 2020 Copyright © 2020 The Travelers' Century Club®

Page 5