Donor Information

First Name
Last Name
Billing Address:
Phone Number:
Email Address:

Donation Amount

I would like to make a donation in the amount of:
Other Amount:
Please display my name on the participant's public donor wall as:

Participant Information

Event Name2024 Toledo Heart Walk
Event ID10173
Participant ID
Participant Name
Team NameArrowhead Medical Center
Team ID841131

Mailing Information

Please send this completed form with checks to:American Heart Association | Attn: AHA Toledo Processing | 1650 Lake Shore Dr, Ste 350 | Columbus, OH 43204