Travelers' Century Club Membership Application To apply for TCC membership, fill out this form and check off the countries you have visited on the list below. Then mail or fax your application with the appropriate initiation fee and dues payment to: Travelers' Century Club Tel: 310-458-3454 P.O. Box 7050 Fax: 310-395-9511 Santa Monica, CA 90406-7050 E-mail: [email protected] INSTRUCTIONS: New members must pay the $!00 per person initiation fee plus the first yearly dues payment (membership fees are detailed at the bottom of this page). Your membership will not be processed without the appropriate fee. You will receive a TCC Membership Card and Membership Certificate, along with periodic issues of our publication, The Centurian. Please allow 6-8 weeks for processing of membership. 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. Total number of countries NAME: ___________________________________________ visited (from list below): _______ SPOUSE (IF ALSO JOINING): ________________________ ADDRESS: _______________________________________ _________________________________________________ TEL: _____________________________________________ E-MAIL: __________________________________________ PAYMENT METHOD: Check American Express Visa MasterCard Name on credit card: ____________________________________ Payment amount: ______________ Card number: __________________________________________ Expiration date: _______________ Zip Code on credit card bill: ___________________ Authorization code (3 or 4 digits): _____________ (Located on front of AmEx Card, back of Visa or MC) Cardholder’s signature: _______________________________________________________________ MEMBERSHIP FEES: Membership fees will not be prorated except for November and December. Please note that higher dues for members requesting mailed Info Files are to cover the cost of printing and mailing (alternatively members may read Info Files on the TCC Web site). • Initiation fee: $100 per member, $100 for spouse • Yearly dues with mailed Info Files: U.S. residents: $75, spouse $65 (residents of other countries: $85, spouse $85) • Yearly dues without mailed Info Files: U.S. residents: $65, spouse $55 (residents of other countries: $75, spouse $75) PROVISIONAL MEMBERSHIP: If you have 75 or more countries and you cannot yet qualify as a full member, you are welcome to attend club meetings. At your request, we will put you on a Provisional Member mailing list to receive The Centurian newsletter. Yearly dues for Provisional Members are listed below (no initiation fee required). • Provisional Membership with mailed Info Files: U.S. residents: $75 (residents of other countries: $85) • Provisional Membership without mailed Info Files: U.S. residents: $65 (residents of other countries: $75) Name: ________________________________________ LIST OF TCC COUNTRIES: PACIFIC OCEAN (39) Australia Midway Island Bismark Archipelago (New Ireland, New Britain, Nauru Bougainville, Admiralty Islands) New Caledonia & Deps. (Noumea, Chatham Islands Loyalty Islands) Cook Islands (Rarotonga, Aitutaki, Penrhyn) Niue Easter Island Norfolk Island Fiji Islands Northern Marianas (Saipan,Tinian) French Polynesia (Tahiti, Tuamotu, Austral, Ogasawara (Bonin, Volcano Is. Iwo Jima) Gambier) Palau, Republic of Galapagos Islands Papua New Guinea Guam Pitcairn Island Hawaiian Islands Ryukyu Islands (Okinawa) Juan Fernandez Islands (Robinson Crusoe Is. Samoa, American (Pago Pago) Kiribati (Gilberts,Tarawa, Ocean Island) Samoa (Apia) Line/Phoenix Islands (Palmyra, Fanning, Solomon Islands (Guadalcanal, New Christmas, Canton, Enderbury, Howland) Georgia, Tulagi) Lord Howe Island Tasmania Marquesas Islands Tokelau Islands (Fakaofu, Atafu, Union) Marshall Islands, Rep. of (Majuro, Kwajalein, Tonga (Nukualofa) Eniwetok) Tuvalu (Ellice Is., Funafuti, Vaitapu) Micronesia, Fed. States of (Pohnpei, Kosrae, Vanuatu (New Hebrides Is.) Chuuk, Yap, Caroline Islands) Wake Island New Zealand Wallis & Futuna Islands NORTH AMERICA (6) Alaska Prince Edward Island Canada St. Pierre & Miquelon Mexico United States (continental) CENTRAL AMERICA (7) Belize (British Honduras) Honduras Costa Rica Nicaragua El Salvador Panama Guatemala SOUTH AMERICA (13) Argentina Guyana (British Guiana) Bolivia Paraguay Brazil Peru Chile Surinam (Netherlands Guiana) Colombia Uruguay Ecuador Venezuela French Guiana CARIBBEAN (30) Anguilla Leeward Islands, Netherlands (Saba, Antigua & Deps. (Barbuda, Redonda) St. Eustatius) Aruba Martinique Bahamas Montserrat Barbados Puerto Rico Bonaire St. Barts Cayman Islands San Andres & Providencia Travelers’ Century Club Membership Application • Page 2 Name: ________________________________________ CARIBBEAN (CONT.) Cuba St. Kitts & Nevis Curacao St. Lucia Dominica St. Maarten (formerly Netherlands Antlles) Dominican Republic St. Vincent & Deps.(Bequia, Canouan, Grenada & Deps. (Carriacou, Grenadines) Grenadines) Guadeloupe & Deps.(Marie Galante) Trinidad & Tobago Haiti Turks & Caicos Islands Jamaica Virgin Islands, U.S.(St. Croix, St. John, Leeward Islands,French (St. Martin) St.Thomas) Virgin Islands, British (Tortola, etc.) ATLANTIC OCEAN (13) Ascension Faroe Islands Azores Islands Greenland (Kalaallit Nunaat) Bermuda Iceland Canary Islands Madeira Cape Verde Islands St. Helena Falkland Islands Tristan de Cunha Fernando do Noronha EUROPE & THE MEDITERRANEAN (67) Aland Islands (Mariehamn) Kosovo Albania Lampedusa Andorra Latvia Austria Liechtenstein Balearic Islands (Mallorca, Minorca) Lithuania Belarus Luxembourg Belgium Macedonia Bosnia & Herzegovina (Sarajevo) Malta Bulgaria Moldova Corsica Monaco Crete Montenegro Croatia Netherlands Cyprus, Republic Norway Cyprus, Turkish Fed. State Poland Czech Republic Portugal Denmark Romania Dodecanese Is. (Rhodes) Russia England San Marino Estonia Sardinia Finland Scotland France Serbia Germany Sicily Gibraltar Slovakia Greece Slovenia Guernsey & Deps (Alderney, Herm, Sark, Spain Channel Islands) Spitsbergen (Svalbard, Bear Island) Hungary Srpska Ionian Islands (Corfu, etc.) Sweden Ireland (Eire) Switzerland Ireland, Northern (Ulster) Trans Dniester Isle of Man Turkey in Europe (Istanbul) Italy Ukraine Jersey (Channel Islands) Vatican City Kaliningrad Wales Travelers’ Century Club Membership Application • Page 3 Name: ________________________________________ ANTARCTICA (7) Argentine (Palmer Peninsula) French Southern & Antarctic Territory Australian Antarctic Territory South Pole (Kerguelen, Crozet, Amsterdam, St. Paul) (Mawson, Davis, Macquarie, Heard) Norwegian (Queen Maud Land, Bouvet) Chilean (Palmer Peninsula) New Zealand (Ross Dependency) Falkland Islands Dependencies (British Antarctica, Graham Land, So. Shetland, So. Sandwich, So. Georgia, So. Orkney) AFRICA (54) Algeria Malawi (Nyasaland) Angola (Port. West Africa) Mali Benin (Dahomey) Mauritania Botswana (Bechuanaland) Morocco Burkina Faso (Upper Volta) Morocco, Spanish (Ceuta, Melilla) Burundi (Urundi) Mozambique (Port. East Africa) Cabinda Namibia Cameroon Niger Central African Rep. Nigeria Chad Rwanda Congo (Brazzaville) Sao Tome & Principe Congo (Kinshasa-Zaire) Senegal Djibouti (French Somaliland, Affars & Issas) Sierra Leone Egypt Somalia (Italian Somaliland) Equatorial Guinea (Rio Muni, Fernando Poo) Somaliland (Brit.) Eritrea South Africa Ethiopia Sudan, North Gabon Sudan, South Gambia Swaziland Ghana (Gold Coast, British Togoland) Tanzania (Tanganyika) Guinea (French Guinea) Togo Guinea-Bissau (Port. Guinea) Tunisia Ivory Coast Uganda Kenya Western Sahara (Spanish Sahara) Lesotho (Basutoland) Zambia (No. Rhodesia) Liberia Zanzibar Libya Zimbabwe (So. Rhodesia) MIDDLE EAST (20) Abu Dhabi Lebanon Ajman Oman Bahrain Palestine Dubai Qatar Fujeirah Ras Al Khaimah Iran Saudi Arabia Iraq Sharjah Israel Syria Jordan Umm Al Qaiwain Kuwait Yemen INDIAN OCEAN (14) Andaman-Nicobar Islands Mauritius & Dependencies. British Indian Ocean Territory (Agalega, St. Brandon) (Chagos Archipelago, Diego Garcia) Mayotte (Dzaoudzi) Christmas Island Reunion & Dependencies Cocos Islands (Keeling) (Tromelin, Glorioso) Travelers’ Century Club Membership Application • Page 4 Name: ________________________________________ INDIAN OCEAN (CONT.) Comoro Islands Rodriguez Island (Anjouan, Moheli, Grand Comoro) Seychelles Lakshadweep Zil Elwannyen Sesel Madagascar (Aldabra, Farquhar, Amirante Islands) Maldive Islands ASIA (51) Abkhazia Macau Afghanistan Malaysia Armenia (Yerevan) Moluka (Moluccas, Indonesia) Azerbaijan (Baku) Mongolia, Rep. Bangladesh Myanmar (Burma) Bhutan Nakhichevan Brunei Nepal Cambodia Pakistan China, People's Rep. Philippines China, Republic of Taiwan Sabah (No. Borneo) Georgia Sarawak Hainan Island Siberia (Russia in Asia) Hong Kong Sikkim India Singapore Indonesia (Java) Sri Lanka (Ceylon) Irian Jaya (Dutch New Guinea) Sulawesi (Celebes, Indonesia) Japan Sumatra (Indonesia) Jeju Island (South Korea) Tajikistan Kalimantan (Indonesian Borneo) Thailand Kashmir Tibet Kazakhstan Timor Leste Kyrgyzstan Turkey in Asia (Anatolia, Ankara, Izmir) Korea, North Turkmenistan Korea, South Uzbekistan Laos Vietnam Lesser Sunda Islands (Bali, Indonesia) THIS LIST IS RECOGNIZED BY THE WORLD AS THE STANDARD OF COUNTRIES AND DESTINATIONS THAT ARE POLITICALLY, ETHNOLOGICALLY OR GEOGRAPHICALLY DIFFERENT. Version: July 2011 Copyright © 2011 The Travelers' Century Club Travelers’ Century Club Membership Application • Page 5 .