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 Name30th Annual San Antonio Heart & Stroke Walk and 5K Run
Event ID9205
Participant ID
Participant Name
Team NameUnitedHealthcare Well-being
Team ID770876

Mailing Information

Please send this completed form with checks to:American Heart Association | Attn: San Antonio Heart & Stroke Walk | 8415 Wurzbach Rd. | San Antonio, TX 78229