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 Sumter Clarendon Heart Walk
Event ID6481
Participant ID23576788
Participant NameMargaret Ezell
Team NameSumter Adult Education
Team ID

Mailing Information

Please send this completed form with checks to:American Heart Association | 701 Gervais Street, Suite 150 PMB#150 | Columbia, SC 29201