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 Kansas City Heart & Stroke Walk
Event ID7019
Participant ID23956024
Participant NameRod Foster
Team NameKansas City Credit Union
Team ID

Mailing Information

Please send this completed form with checks to:American Heart Association | 5800 Foxridge Dr. #108 | Mission, KS 66202