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 Name2020 Metro Detroit Heart and Stroke Walk/Run
Event ID4904
Participant ID2117734
Participant NameKathleen Penley
Team NameOperation Pump it Up
Team ID

Mailing Information

Please send this completed form with checks to:27777 Franklin Rd., Suite 1150, Southfield, MI 48034