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 Name
2022 Cincinnati Heart Mini-Marathon & Walk
Event ID
6491
Participant ID
16950585
Participant Name
Kim Barrett
Team Name
Product Strategy 2022 Cincinnati Heart Mini
Team ID
Mailing Information
Please send this completed form with checks to: