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 Kern County Heart and Stroke Walk
Event ID10753
Participant ID2001408
Participant NamePriscilla Bacus
Team NameKing and Queen of Hearts
Team ID

Mailing Information

Please send this completed form with checks to:American Heart Association | Attn: Kern County Walk | 816 S Figueroa St, Ste 200 | Los Angeles, CA 90017