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 Name2025 Dallas Heart Walk
Event ID11981
Participant ID30746632
Participant NameMaria Cielo Borrinaga
Team NameRed Hot Chili Steppers
Team ID
Mailing Information
Please send this completed form with checks to:American Heart Association | Attn: Dallas Heart Walk | PO Box 5029 | Boone, IA 50950