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 Name2024 Corridor Heart Walk
Event ID9864
Participant ID
Participant Name
Team NameUniversity of Iowa Csomay Center
Team ID839344

Mailing Information

Please send this completed form with checks to:American Heart Association | Attn: Corridor Heart Walk | 1035 N Center Point Rd., Suite B | Hiawatha, IA 52233