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 Name
2024 Central Iowa Heart Walk
Event ID
9949
Participant ID
28288694
Participant Name
Drew Johnston
Team Name
80-35 Built
Team ID
Mailing Information
Please send this completed form with checks to: