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 Name2022 Northwest Ohio Heart Walk
Event ID6384
Participant ID23849049
Participant NameMonica Kuhr
Team NameITS HeartThrobs!
Team ID

Mailing Information

Please send this completed form with checks to:American Heart Association | 5455 North High Street | Columbus, OH 43214