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:
Other Amount:
Please display my name on the participant's public donor wall as:

Participant Information

Event Name2024 Indianapolis Heart Walk
Event ID10700
Participant ID28628773
Participant NameMary Herndon
Team NameJust Your Average Heart
Team ID

Mailing Information

Please send this completed form with checks to:American Heart Association | Attn: Indy Heart Walk | 8720 Castle Creek Pkwy E Dr #100 | Indianapolis, IN 46250