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 Name
2024 Northland Heart Walk
Event ID
11133
Participant ID
28497998
Participant Name
Megan Forsyth
Team Name
Aspirus St. Luke's
Team ID
Mailing Information
Please send this completed form with checks to:
American Heart Association | Attn: Northland Heart Walk | 2750 Blue Water Rd, Ste 250 | Eagan, MN 55121