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 Metro Chicago Heart Walk
Event ID13141
Participant ID11436127
Participant NameJeff Burns
Team NameKPMG Tax
Team ID
Mailing Information
Please send this completed form with checks to:American Heart Association | Attn: Metro Chicago Walk | 300 S Riverside Plaza, Ste 1200 | Chicago, IL, 60606