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 SE Wisconsin Heart & Stroke Walk/5k Run
Event ID7017
Participant ID9096223
Participant NamePeter Feigin
Team NameJim Feigin Memorial
Team ID

Mailing Information

Please send this completed form with checks to: