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 York Heart Walk
Event ID12089
Participant ID3147740
Participant NameMissy Mulcahy Fischer
Team NameRun With Heart
Team ID
Mailing Information
Please send this completed form with checks to:American Heart Association | Attn: York Heart Walk | 4250 Crums Mill Rd, Ste 100 | Harrisburg, PA 17112