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:
Other Amount:
Please display my name on the participant's public donor wall as:

Participant Information

Event Name2024 Cincinnati Heart Mini-Marathon & Walk
Event ID9843
Participant ID2029367
Participant NameValerie Kalti
Team NameIT Has Heart
Team ID

Mailing Information

Please send this completed form with checks to:American Heart Association | Attn: Heart Mini | 9825 Kenwood Rd, Ste 104 | Blue Ash, OH 45242