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 Long Island Heart Walk
Event ID10711
Participant ID
Participant Name
Team NameHenry Schein Corporate Finance
Team ID835574

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