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 Tuscaloosa Heart Walk
Event ID6421
Participant ID3102616
Participant NameAllison Smith
Team NameAlabama Credit Union Five Points Team
Team ID

Mailing Information

Please send this completed form with checks to:American Heart Association | 6275 University Blvd Ste. 37 #120 | Huntsville, AL 35806