Travelers' Century Club Membership Application

1 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 Tel: (888) 822-0228. 8939 S. Sepulveda Blvd., Suite 102 E-mail: Los Angeles, CA 90045. 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.

2 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 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: residents: $85, spouse $65 (residents of other countries: $95, spouse $65).)

3 Yearly dues without mailed Info Files: 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: residents: $85 (residents of other countries: $95). Provisional Membership without mailed Info Files: residents: $75 (residents of other countries: $85). Name: _____. LIST OF TCC COUNTRIES AND TERRITORIES: PACIFIC OCEAN (39). ! Australia ! Nauru ! Bismark Archipelago (New Ireland, New Britain, ! New Caledonia & Deps. (Noumea, Bougainville, Admiralty Islands) Loyalty Islands).

4 ! Chatham Islands ! New Zealand ! Cook Islands (Rarotonga, Aitutaki, Penrhyn) ! Niue ! Easter Island ! Norfolk Island ! Fiji Islands ! Northern Marianas (Saipan, Tinian). ! French Polynesia (Tahiti, Tuamotu, Austral, ! Ogasawara (Bonin, Volcano Island, 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, Western (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 Island, Funafuti, Vaitapu).

5 ! Micronesia, Fed. States of (Pohnpei, Kosrae, ! Vanuatu (New Hebrides Islands). Chuuk,Yap, Caroline Islands) ! Wake Island ! Midway Island ! 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 (14). ! Argentina ! Guyana (British Guiana). ! Bolivia ! Nueva Esparta (Margarita Island). ! Brazil ! Paraguay ! Chile ! Peru ! Colombia ! Surinam (Netherlands Guiana). ! Ecuador ! Uruguay ! French Guiana ! Venezuela CARIBBEAN (30). ! Anguilla ! Martinique ! Antigua & Deps. (Barbuda, Redonda) ! Montserrat ! Aruba ! Puerto Rico ! Bahamas ! St. Barts ! Barbados ! San Andres & Providencia ! Bonaire ! St. Kitts & Nevis ! Cayman Islands travelers ' Century club Membership Application !

6 Page 2. Name: _____. CARIBBEAN (CONT.). ! Cuba ! St. Lucia ! Curacao ! St. Maarten (formerly Netherlands Antilles). ! Dominica ! St. Vincent & Deps. (Bequia, Canouan, ! Dominican Republic Grenadines). ! Grenada & Deps. (Carriacou, Grenadines) ! Trinidad & Tobago ! Guadeloupe & Deps. (Marie Galante) ! Turks & Caicos Islands ! Haiti ! Virgin Islands, (St. Croix, St. John, ! Jamaica St. Thomas). ! Leeward Islands, French (St. Martin) ! Virgin Islands, British (Tortola, etc.). ! Leeward Islands, Netherlands (Saba, St. Eustatius). ATLANTIC OCEAN (13). ! Ascension ! Fernando do Noronha ! Azores Islands ! Faroe Islands ! Bermuda ! Greenland (Kalaallit Nunaat). ! Canary Islands ! Iceland ! Cape Verde Islands ! Madeira ! Falkland Islands ! St. Helena ! Tristan da Cunha EUROPE & THE MEDITERRANEAN (67). ! Aland Islands (Mariehamn) ! Kosovo ! Albania ! Lampedusa ! Andorra ! Latvia !

7 Austria ! Liechtenstein ! Balearic Islands (Mallorca, Minorca) ! Lithuania ! Belarus ! Luxembourg ! Belgium ! Macedonia ! Bosnia & Herzegovina ! 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). travelers ' Century club Membership Application ! Page 3. Name: _____.

8 EUROPE & THE MEDITERRANEAN (CONT.). ! Italy ! Ukraine ! Jersey (Channel Islands) ! Vatican City ! Kaliningrad ! Wales 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). ! British Antarctica (Graham Land, South Shetland, South Orkney). AFRICA (55). ! Algeria ! Malawi (Nyasaland). ! Angola (Port. West Africa) ! Mali (French Soudan). ! 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 Republic ! Nigeria ! Chad ! Rwanda (Ruanda).

9 ! Congo (Brazzaville) ! Sao Tome & Principe ! Congo (Kinshasa-Zaire) ! Senegal ! Djibouti (French Somaliland, Affars & Issas) ! Sierra Leone ! Egypt in Africa ! Somalia (Italian Somaliland). ! Equatorial Guinea (Bioko, Fernando Poo) ! Somaliland (British). ! Equatorial Guinea (Rio Muni) ! South Africa ! Eritrea ! South Sudan ! Ethiopia ! Sudan ! Gabon ! Swaziland ! Gambia ! Tanzania (Tanganyika). ! Ghana (Gold Coast, British Togoland) ! Togo ! Guinea (French Guinea) ! Tunisia ! Guinea-Bissau (Port. Guinea) ! Uganda ! Ivory Coast ! Western Sahara (Spanish Sahara). ! Kenya ! Zambia (No. Rhodesia). ! Lesotho (Basutoland) ! Zanzibar ! Liberia ! Zimbabwe (So. Rhodesia). ! Libya MIDDLE EAST (21). ! Abu Dhabi ! Lebanon ! Ajman ! Oman ! Bahrain ! Palestine ! Dubai ! Qatar ! Egypt in Asia (Sinai Peninsula) ! Ras Al Khaimah ! Fujeirah ! Saudi Arabia ! Iran ! Sharjah ! Iraq !

10 Syria ! Israel ! Umm Al Qaiwain ! Jordan ! Yemen ! Kuwait travelers ' Century club Membership Application ! 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 & Dependencies ! Cocos Islands (Keeling) (Tromelin, Glorioso). ! Comoro Islands ! Rodrigues Island (Anjouan, Moheli, Grand Comoro) ! Seychelles ! Lakshadweep ! Socotra ! Malagasy Republic (Madagascar) ! Zil Elwannyen Sesel ! Maldive Islands (Aldabra, Farquhar, Amirante Islands). ASIA (51). ! Abkhazia ! Malaysia ! Afghanistan ! Moluka (Moluccas, Indonesia). ! Armenia (Yerevan) ! Mongolia, Republic ! Azerbaijan (Baku) ! Myanmar (Burma). ! Bangladesh ! Nakhchivan ! Bhutan ! Nepal ! Brunei ! Pakistan ! Cambodia ! Papua (Irian Jaya).