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 Midlands Heart Walk
Event ID12626
Participant ID
Participant Name
Team NameThis Is Only A Drill
Team ID955290
Mailing Information
Please send this completed form with checks to:American Heart Association | Attn: Midlands Heart Walk | 887 Johnnie Dodds Blvd, Ste 110 | Mt. Pleasant, SC 29464