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:
$1000
$500
$250
$120
$60
$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 Name2024 Toledo Heart Walk
Event ID10173
Participant ID28472934
Participant NameDuane Chovan
Team NameIn Honor of Gopi Upamaka
Team ID
Mailing Information
Please send this completed form with checks to: