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:
$1000
$500
$250
$120
$60
$35
Other Amount:
Please display my name on the participant's public donor wall as:
Please do not display my name on the donor wall.
Participant Information
Event Name
2022 San Diego Heart & Stroke Walk
Event ID
7025
Participant ID
24122483
Participant Name
Genel Ronquillo
Team Name
San Diego State University Team
Team ID
Mailing Information
Please send this completed form with checks to: