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 Name
2024 Kern County Heart and Stroke Walk
Event ID
10753
Participant ID
3623887
Participant Name
Billie Reynolds
Team Name
King and Queen of Hearts
Team ID
Mailing Information
Please send this completed form with checks to: