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:
Other Amount:
Please display my name on the participant's public donor wall as:

Participant Information

Event Name2022 Dallas Heart Walk
Event ID7021
Participant ID
Participant Name
Team NameComm Health, Development and Strategy Integration
Team ID707164

Mailing Information

Please send this completed form with checks to:American Heart Association | PO Box 4002903 | Des Moines, IA 50340