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 Washtenaw County Heart & Stroke Walk
Event ID11401
Participant ID
Participant Name
Team NameHigh Seas
Team ID890258
Mailing Information
Please send this completed form with checks to:American Heart Association | Attn: Washtenaw Coutny Walk | 26555 Evergreen Rd, Ste 570 | Southfield, MI 48076