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 Name31st Annual Bert Blain Memorial Heart Walk
Event ID11073
Participant ID11411993
Participant NameChristine Miller
Team NameBlain's DC, Shop, Transportation
Team ID
Mailing Information
Please send this completed form with checks to:American Heart Association | Attn: Bert Blain Memorial Heart Walk | 2850 Dairy Dr, Ste #130 | Madison, WI 53718