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 Oregon and SW Washington Heart & Stroke Walk
Event ID9944
Participant ID21710040
Participant NameTimothy Tedder
Team NameTeam Vancouver Clinic
Team ID

Mailing Information

Please send this completed form with checks to:American Heart Association | Attn: Oregon & SW Washington Walk | 4380 SW Macadam Ave, Ste 480 | Portland, OR 97239