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 Kansas City Heart & Stroke Walk
Event ID10757
Participant ID
Participant Name
Team NameAWG Cares
Team ID838851

Mailing Information

Please send this completed form with checks to:American Heart Association | Attn: Kansas City Heart & Stroke Walk | 5800 Foxridge Drive #108 | Mission, KS 66202