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 Dallas Heart Walk
Event ID10721
Participant ID28580218
Participant NameMelissa Johnson
Team NameQuality & Health IT
Team ID
Mailing Information
Please send this completed form with checks to:American Heart Association | Attn: Dallas Heart Walk | PO Box 4002903 | Des Moines, IA 50340