Donor Information
First Name
Last Name
Billing Address:
City:
State:
Zip:
Phone Number:
Email Address:
Donation Amount
I would like to make a donation in the amount of:
$250
$150
$75
$35
Other Amount:
Please display my name on the participant's public donor wall as:
Please do not display my name on the donor wall.
Participant Information
Event NameBoston Teen of Impact - Spring 2026
Event ID13274
Participant ID31508541
Participant NamePenelope Ghisleni
Team NameSophia Chan
Team ID
Mailing Information
Please send this completed form with checks to:American Heart Association | Attn: Boston TOI | 4217 Park Place Ct. | Glen Allen, VA 23060