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 Lynchburg Heart Walk
Event ID
10084
Participant ID
26116763
Participant Name
Kathy McDonald
Team Name
Happy Hearts
Team ID
Mailing Information
Please send this completed form with checks to: