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 Alaska Heart Run and Walk
Event ID12052
Participant ID30361866
Participant NameCedric Watson
Team NameWake Up Alaska
Team ID
Mailing Information
Please send this completed form with checks to:American Heart Association | Attn: Alaska Run/Walk | 4380 S Macadam Ave, Ste 480 | Portland, OR 97239