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 Midlands Heart Walk
Event ID9850
Participant ID26857034
Participant NameMichele Johnson
Team NameSC Technical College System
Team ID

Mailing Information

Please send this completed form with checks to:American Heart Association | Attn: Midlands Heart Walk | 887 Johnnie Dodds Blvd. Suite 110 | Mount Pleasant, SC 29464