Organic Cotton T-Shirt Program | Quiksilver Foundation

Thank you for purchasing an organic t-shirt and sharing our commitment to a healthy environment. If the organic t-shirt you purchased came with a special "Choose Your Cause" hangtag, then an amount equal to three percent (3%) of the net sales price (excluding taxes and any other charges or assessments) of this t-shirt will be donated by Quiksilver to the Quiksilver Foundation, a non-profit charitable organization. The Quiksilver Foundation would like to provide you with the opportunity to direct the donations received from Quiksilver in the "Choose Your Cause" Program. In order to do so, please check one of the boxes below to indicate your support for that charitable organization, complete the registration information below, and submit this form. Your submission of this form will evidence your understanding of, and agreement to, all of the terms and conditions provided for in this form and The Quiksilver Foundation privacy policy.

Check one of the boxes below to indicate your support for that charitable organization.


	Surfrider Foundation The Surfrider Foundation is a non-profit environmental organization dedicated to the protection and enjoyment of the world’s oceans, waves and beaches for all people, through conservation, activism, research and education. Website: surfrider.org


	Keep A Breast The Keep A Breast Foundation is a unique non-profit organization whose mission is to produce art events to increase breast cancer awareness among young people and benefit breast cancer education, prevention and treatment programs in communities around the world. Website: keep-a-breast.org

The Quiksilver Foundation
The Quiksilver Foundation is a non-profit organization committed to benefiting and enhancing the quality of life for communities of boardriders across the world in support of environmental, educational, health and youth-related projects. With offices in France, Australia and the United States, Quiksilver is able to provide assistance to a host of charitable initiatives, organizations and projects, such as Reef Check, SurfAid International, the Sumba Foundation, QuikSCience.
Website: quiksilverfoundation.org

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Terms and Conditions of the "Choose Your Cause" Program

Through the "Choose Your Cause" Program (the "Program"), Quiksilver will donate to The Quiksilver Foundation an amount equal to three percent (3%) of the net sales price (excluding taxes and any other charges or assessments) for each "Quiksilver" and "Roxy" branded organic t-shirt, purchased by a retail customer, that has a special "Choose Your Cause" hangtag attached to the t-shirt (each, a "Participating Product"). Any products that do not have a "Choose Your Cause" hangtag attached to the garment will be ineligible for the Program, and Quiksilver will not donate any amounts to The Quiksilver Foundation in connection therewith. Initially, Quiksilver will make all donations to the Quiksilver Foundation. Each purchaser of a Participating Product may irrevocably select one of the charitable organizations identified above (individually, a "Charity, collectively, the "Charities"), and all of the proceeds received by The Quiksilver Foundation in connection with the Program will then be allocated by The Quiksilver Foundation to the specific Charities selected by retail purchasers of Participating Products by dividing the aggregate number of "selections" for a particular Charity by the total number Participating Products purchased during the Term (defined below). For example, if 1000 Participating Products are purchased during the Term, and 100 participating retail purchasers select the Surfrider Foundation Charity, complete the Registration Information and submit this form during the Term of the Program, then 10% of the total donation received by The Quiksilver Foundation in connection with the Program will be directed to the Surfrider Foundation. In the event a retail purchaser of a Participating Product does not select a Charity by visiting The Quiksilver Foundation website and completing and submitting the Registration Information, such purchasers will be deemed to have selected The Quiksilver Foundation and any donations received by The Quiksilver Foundation from the sales of such Participating Products during the Term of the Program will be allocated to and retained by The Quiksilver Foundation. Each retail purchaser of a Participating Product may only select one Charity for each Participating Product purchased by such purchaser during the Term of the Program, and such purchaser may not change his / her selection after it has been made.

The Program will commence on _______, 2006 and will terminate on the earlier to occur of (i) the sales of all Participating Products, or (ii) __________, 2006 (the "Term"). The Quiksilver Foundation will calculate and make the appropriate donations to the other applicable Charities (if any) within sixty (60) days of the end of the Term. Quiksilver, The Quiksilver Foundation and their respective owners, subsidiaries and affiliates each reserves the right to discontinue, terminate or suspend the Program and/or the sale of Participating Products, and to modify, alter, supplement, add to or discontinue any or all of the terms and conditions of the Program at any time and from time to time, in their sole and absolute discretion.

All registration information collected by The Quiksilver Foundation in connection with the Program will be used in accordance with its privacy policy located at http://www.quiksilverfoundation.org/privacypolicy.php .