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 Name2022 Twin Cities Heart Walk
Event ID6410
Participant ID17043859
Participant NameKenzie Lund
Team NameKisses For Kenzie
Team ID
Mailing Information
Please send this completed form with checks to: