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 Name2024 Central Kentucky Heart Walk
Event ID10075
Participant ID28447455
Participant NameJeremy Stacy
Team NameUK Laboratory Services
Team ID
Mailing Information
Please send this completed form with checks to:American Heart Association | Attn: Central Kentucky Heart Walk | 354 Waller Ave, Ste 110 | Lexington, KY 40504