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 Alaska Heart Run and Walk
Event ID10720
Participant ID
Participant Name
Team NameProvidence St. Elias Specialty Hospital
Team ID857279

Mailing Information

Please send this completed form with checks to:American Heart Association | Attn: Alaska Heart Run | 4380 S Macadam Ave, Ste 480 | Portland, OR 97239