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 Cleveland Heart Walk
Event ID7022
Participant ID22016989
Participant NameTimothy Barnett
Team NameLutheran Medical Staff
Team ID

Mailing Information

Please send this completed form with checks to:American Heart Association | 1375 East 9th St, Ste 600 | Cleveland, OH 44114