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 Wayne County Heart Walk
Event ID10915
Participant ID28622241
Participant NamePaul Hugon
Team NameThe Diamond Walkers
Team ID

Mailing Information

Please send this completed form with checks to:American Heart Association | Attn: Wayne County Heart Walk | 1575 Corporate Woods Pkwy | Uniontown, OH 44685