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 Name2025 Hudson Valley Heart Walk
Event ID11389
Participant ID
Participant Name
Team NameHudson Valley Credit Union
Team ID895317
Mailing Information
Please send this completed form with checks to:American Heart Association | Attn: Hudson Valley Heart Walk | Four Gateway Center444 Liberty Ave, Ste 1300 | Pittsburgh, PA 15222