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 Name2026 Syracuse Heart Walk
Event ID12614
Participant ID
Participant Name
Team NameUHCC Cardiology
Team ID947790
Mailing Information
Please send this completed form with checks to:American Heart Association | Attn: Syracuse Heart Walk | 444 Liberty Ave, Ste 1300 | Pittsburgh, PA 15222