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 Name2024 Long Island Heart Walk
Event ID10711
Participant ID24203726
Participant NameTiffany Lopez
Team NameBellmore Beat
Team ID
Mailing Information
Please send this completed form with checks to:American Heart Association | Attn: Long Island Heart Walk | 145 Pinelawn Road, Suite 240N | Melville, NY 11747