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 Puget Sound Heart & Stroke Walk
Event ID10893
Participant ID28318085
Participant NameNirmal Bhandari
Team NameBeats Per Mile - WOA PNW
Team ID
Mailing Information
Please send this completed form with checks to:American Heart Association | Attn: Puget Sound Walk | 601 Union St, Ste 2420 | Seattle, WA 98101