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:
$1000
$500
$250
$120
$60
$35
Other Amount:
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 York Heart Walk
Event ID10730
Participant ID
Participant Name
Team NamePewee's posse
Team ID850330
Mailing Information
Please send this completed form with checks to:American Heart Association | Attn: York Heart Walk | 4250 Crums Mill Rd, Ste 100 | Harrisburg, PA 17112