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 Greater Akron Heart Walk
Event ID9883
Participant ID28376440
Participant NameJames Ferrell
Team NameCenter for Family Medicine
Team ID

Mailing Information

Please send this completed form with checks to:American Heart Association | Attn: Greater Akron Heart Walk | 1575 Corporate Woods Pkwy, Ste 150 | Uniontown, OH 44685