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 Greater Akron Heart Walk
Event ID7002
Participant ID24261434
Participant NameAlec and Diane Pacella
Team NamePleasant Valley Corporation
Team ID

Mailing Information

Please send this completed form with checks to: