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 Greater Hartford Heart Walk
Event ID12014
Participant ID30673628
Participant NameMargaret Bahre
Team NameHH CV OR
Team ID
Mailing Information
Please send this completed form with checks to:American Heart Association | Attn: Hartford Heart Walk | Eastern States-Accts Rec, PO Box 4002012 | Des Moines, IA 50340