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 Stark Heart Walk
Event ID7058
Participant ID2677884
Participant NameLeslie Heaphy
Team NameKent Stark Honors
Team ID

Mailing Information

Please send this completed form with checks to:American Heart Association | 1575 Corporate Woods Pkwy, Ste 150 | Uniontown, OH 44685