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 Sumter Clarendon Heart Walk
Event ID12110
Participant ID25133943
Participant NameMs McKnight
Team NameSumter Academy for Support and Intervention
Team ID
Mailing Information
Please send this completed form with checks to: