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:
Other Amount:
Please display my name on the participant's public donor wall as:

Participant Information

Event Name2022 Twin Cities Heart Walk
Event ID6410
Participant ID17833776
Participant NameGeorge's Troopers
Team NameEvery Individual Step Counts (EIS)
Team ID

Mailing Information

Please send this completed form with checks to:American Heart Association | 2750 Blue Water Rd, Ste 250 | Eagan, MN 55121