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 Inland Empire Heart & Stroke Walk
Event ID9934
Participant ID
Participant Name
Team Name1RIV_RmcFans
Team ID841514

Mailing Information

Please send this completed form with checks to:American Heart Association | Attn: Inland Empire Walk | 5251 California Ave, Ste #230 | Irvine, CA 92617