Travelers' Century Club Membership Application To apply for TCC membership, fill out this form and check off the destinations you have visited on the list below. Then mail your application with the appropriate initiation fee and dues payment to: Travelers' Century Club 8939 S. Sepulveda Blvd., Suite 102 Los Angeles, CA 90045
Tel: (888) 822-0228 E-mail:
[email protected]
INSTRUCTIONS: New members must pay the $100 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 destinations NAME: ____________________________________________ visited (from list below): ________ SPOUSE (IF ALSO JOINING): __________________________ ADDRESS: _________________________________________ __________________________________________________ TEL: ______________________________________________ E-MAIL: ___________________________________________ Payment Method:
Check
American Express
Visa
MasterCard
PayPal
(The Travelers' Century Club PayPal ID is
[email protected])
Name on credit card: _______________________________________ Payment amount: __________ Card number: ________________________________________ Expiration date: __________________ Zip/postal code on billing address: _______________________ Authorization code: _______________ (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 Forum Web site). • Initiation fee: $100 per member, $100 for spouse • Yearly dues with mailed Info Files: U.S. residents: $85, spouse $65 (residents of other countries: $95, spouse $65) • Yearly dues without mailed Info Files: U.S. residents: $75, spouse $65 (residents of other countries: $85, spouse $65) PROVISIONAL MEMBERSHIP: If you have 75 or more countries and territories 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: $85 (residents of other countries: $95) • Provisional Membership without mailed Info Files: U.S. residents: $75 (residents of other countries: $85)
Name: ________________________________
LIST OF TCC COUNTRIES AND TERRITORIES: PACIFIC OCEAN (39) ! Australia ! Bismark Archipelago (New Ireland, New Britain, Bougainville, Admiralty Islands) ! Chatham Islands ! Cook Islands (Rarotonga, Aitutaki, Penrhyn) ! Easter Island ! Fiji Islands ! French Polynesia (Tahiti, Tuamotu, Austral, Gambier) ! Galapagos Islands ! Guam ! Hawaiian Islands ! Juan Fernandez Islands (Robinson Crusoe Is.) ! Kiribati (Gilberts, Tarawa, Ocean Island) ! Line/Phoenix Islands (Palmyra, Fanning, Christmas, Canton, Enderbury, Howland) ! Lord Howe Island ! Marquesas Islands ! Marshall Islands, Rep. of (Majuro, Kwajalein, Eniwetok) ! Micronesia, Fed. States of (Pohnpei, Kosrae, Chuuk,Yap, Caroline Islands) ! Midway Island
! Nauru ! New Caledonia & Deps. (Noumea, Loyalty Islands) ! New Zealand ! Niue ! Norfolk Island ! Northern Marianas (Saipan, Tinian) ! Ogasawara (Bonin, Volcano Island, Iwo Jima) ! Palau, Republic of ! Papua New Guinea ! Pitcairn Island ! Ryukyu Islands (Okinawa) ! Samoa, American (Pago Pago) ! Samoa, Western (Apia) ! Solomon Islands (Guadalcanal, New Georgia, Tulagi) ! Tasmania ! Tokelau Islands (Fakaofu, Atafu, Union) ! Tonga (Nukualofa) ! Tuvalu (Ellice Island, Funafuti, Vaitapu) ! Vanuatu (New Hebrides Islands) ! Wake Island ! Wallis & Futuna Islands
NORTH AMERICA (6) ! Alaska ! Canada ! Mexico
! Prince Edward Island ! St. Pierre & Miquelon ! United States (continental) CENTRAL AMERICA (7)
! ! ! !
Belize (British Honduras) Costa Rica El Salvador Guatemala
! Honduras ! Nicaragua ! Panama SOUTH AMERICA (14)
! ! ! ! ! ! !
Argentina Bolivia Brazil Chile Colombia Ecuador French Guiana
! ! ! ! ! ! !
Guyana (British Guiana) Nueva Esparta (Margarita Island) Paraguay Peru Surinam (Netherlands Guiana) Uruguay Venezuela
CARIBBEAN (30) ! ! ! ! ! ! !
Anguilla Antigua & Deps. (Barbuda, Redonda) Aruba Bahamas Barbados Bonaire Cayman Islands
! ! ! ! ! !
Martinique Montserrat Puerto Rico St. Barts San Andres & Providencia St. Kitts & Nevis
Travelers' Century Club Membership Application ! Page 2
Name: ________________________________
CARIBBEAN (CONT.) ! ! ! ! ! ! ! ! ! !
Cuba Curacao Dominica Dominican Republic Grenada & Deps. (Carriacou, Grenadines) Guadeloupe & Deps. (Marie Galante) Haiti Jamaica Leeward Islands, French (St. Martin) Leeward Islands, Netherlands (Saba, St. Eustatius)
! St. Lucia ! St. Maarten (formerly Netherlands Antilles) ! St. Vincent & Deps. (Bequia, Canouan, Grenadines) ! Trinidad & Tobago ! Turks & Caicos Islands ! Virgin Islands, U.S. (St. Croix, St. John, St. Thomas) ! Virgin Islands, British (Tortola, etc.)
ATLANTIC OCEAN (13) ! ! ! ! ! !
Ascension Azores Islands Bermuda Canary Islands Cape Verde Islands Falkland Islands
! ! ! ! ! ! !
Fernando do Noronha Faroe Islands Greenland (Kalaallit Nunaat) Iceland Madeira St. Helena Tristan da Cunha
EUROPE & THE MEDITERRANEAN (67) ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !
Aland Islands (Mariehamn) Albania Andorra Austria Balearic Islands (Mallorca, Minorca) Belarus Belgium Bosnia & Herzegovina Bulgaria Corsica Crete Croatia Cyprus, Republic Cyprus, Turkish Fed. State Czech Republic Denmark Dodecanese Is. (Rhodes) England Estonia Finland France Germany Gibraltar Greece Guernsey & Deps (Alderney, Herm, Sark, Channel Islands) Hungary Ionian Islands (Corfu, etc.) Ireland (Eire) Ireland, Northern (Ulster) Isle of Man
! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !
Kosovo Lampedusa Latvia Liechtenstein Lithuania Luxembourg Macedonia Malta Moldova Monaco Montenegro Netherlands Norway Poland Portugal Romania Russia San Marino Sardinia Scotland Serbia Sicily Slovakia Slovenia Spain Spitsbergen (Svalbard, Bear Island) Srpska Sweden Switzerland Trans Dniester Turkey in Europe (Istanbul)
Travelers' Century Club Membership Application ! Page 3
Name: ________________________________
EUROPE & THE MEDITERRANEAN (CONT.) ! Italy ! Jersey (Channel Islands) ! Kaliningrad
! Ukraine ! Vatican City ! Wales ANTARCTICA (7)
! Argentine (Palmer Peninsula) ! Australian Antarctic Territory South Pole (Mawson, Davis, Macquarie, Heard) ! Chilean (Palmer Peninsula) ! British Antarctica (Graham Land, South Shetland, South Orkney)
! French Southern & Antarctic Territory (Kerguelen, Crozet, Amsterdam, St. Paul) ! Norwegian (Queen Maud Land, Bouvet) ! New Zealand (Ross Dependency)
AFRICA (55) ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !
Algeria Angola (Port. West Africa) Benin (Dahomey) Botswana (Bechuanaland) Burkina Faso (Upper Volta) Burundi (Urundi) Cabinda Cameroon Central African Republic Chad Congo (Brazzaville) Congo (Kinshasa-Zaire) Djibouti (French Somaliland, Affars & Issas) Egypt in Africa Equatorial Guinea (Bioko, Fernando Poo) Equatorial Guinea (Rio Muni) Eritrea Ethiopia Gabon Gambia Ghana (Gold Coast, British Togoland) Guinea (French Guinea) Guinea-Bissau (Port. Guinea) Ivory Coast Kenya Lesotho (Basutoland) Liberia Libya
! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !
Malawi (Nyasaland) Mali (French Soudan) Mauritania Morocco Morocco, Spanish (Ceuta, Melilla) Mozambique (Port. East Africa) Namibia Niger Nigeria Rwanda (Ruanda) Sao Tome & Principe Senegal Sierra Leone Somalia (Italian Somaliland) Somaliland (British) South Africa South Sudan Sudan Swaziland Tanzania (Tanganyika) Togo Tunisia Uganda Western Sahara (Spanish Sahara) Zambia (No. Rhodesia) Zanzibar Zimbabwe (So. Rhodesia)
MIDDLE EAST (21) ! ! ! ! ! ! ! ! ! ! !
Abu Dhabi Ajman Bahrain Dubai Egypt in Asia (Sinai Peninsula) Fujeirah Iran Iraq Israel Jordan Kuwait
! ! ! ! ! ! ! ! ! !
Lebanon Oman Palestine Qatar Ras Al Khaimah Saudi Arabia Sharjah Syria Umm Al Qaiwain Yemen
Travelers' Century Club Membership Application ! Page 4
Name: ________________________________
INDIAN OCEAN (15) ! Andaman-Nicobar Islands ! British Indian Ocean Territory (Chagos Archipelago, Diego Garcia) ! Christmas Island ! Cocos Islands (Keeling) ! Comoro Islands (Anjouan, Moheli, Grand Comoro) ! Lakshadweep ! Malagasy Republic (Madagascar) ! Maldive Islands
! Mauritius & Dependencies (Agalega, St. Brandon) ! Mayotte (Dzaoudzi) ! Reunion & Dependencies (Tromelin, Glorioso) ! Rodrigues Island ! Seychelles ! Socotra ! Zil Elwannyen Sesel (Aldabra, Farquhar, Amirante Islands) ASIA (51)
! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !
Abkhazia Afghanistan Armenia (Yerevan) Azerbaijan (Baku) Bangladesh Bhutan Brunei Cambodia China, People's Republic China, Republic of Taiwan Georgia Hainan Island Hong Kong India Indonesia (Java) Japan Jeju Island (South Korea) Kalimantan (Indonesian Borneo) Kashmir Kazakhstan Kyrgyzstan Korea, North Korea, South Laos Lesser Sunda Islands (Bali, Indonesia) Macau
! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !
Malaysia Moluka (Moluccas, Indonesia) Mongolia, Republic Myanmar (Burma) Nakhchivan Nepal Pakistan Papua (Irian Jaya) Philippines Sabah (North Borneo) Sarawak Siberia (Russia in Asia) Sikkim Singapore Sri Lanka (Ceylon) Sulawesi (Celebes, Indonesia) Sumatra (Indonesia) Tajikistan Thailand Tibet Timor Leste Turkey in Asia (Anatolia, Ankara, Izmir) Turkmenistan Uzbekistan Vietnam
THIS LIST IS RECOGNIZED BY THE WORLD AS THE STANDARD OF COUNTRIES AND TERRITORIES THAT ARE POLITICALLY, ETHNOLOGICALLY OR GEOGRAPHICALLY DIFFERENT. Version: June 2016 Copyright © 2016 The Travelers' Century Club
Travelers' Century Club Membership Application ! Page 5
