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 Greater Charlotte Heart Walk
Event ID13243
Participant ID24104243
Participant NameNeal Blinde
Team NameTeam Qasim
Team ID
Mailing Information
Please send this completed form with checks to:American Heart Association | Attn: Charlotte Heart Walk | 5445 77 Center Dr, Ste 60 | Charlotte, NC 28217