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 Name2023 Greater Cleveland Heart Walk
Event ID9014
Participant ID
Participant Name
Team NameTeam STERIS
Team ID765769
Mailing Information
Please send this completed form with checks to:American Heart Association | Attn: Greater Cleveland Heart Walk | 1375 East 9th Street, Suite 600 | Cleveland, OH 44114