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 Name2021 Kansas City Heart & Stroke Walk
Event ID6069
Participant ID
Participant Name
Team NameTUKH High 5 Hearts
Team ID632948

Mailing Information

Please send this completed form with checks to:American Heart Association | 13851 W 63rd St. #346 | Shawnee, KS 66216