Memorial & Tribute Banner Order Form

Memorial & Tribute Banner Order Form
Many of us have had a relative, close friend, or colleague who has been affected by heart disease or stroke. The Memorial and Tribute Banners are displayed every year at the Phoenix Heart Walk to recognize these special people. With this form, you can honor your loved ones, while contributing to the critical fundraising that fights heart disease and stroke.
Once your form has been completed, an AHA staff member will contact you to confirm your banner details and request a photo. Completed forms, photographs and payments are due NO LATER THAN Monday, March 7th, 2022 (No exceptions will be allowed due to time needed for banner creation). Payment options are outlined below. The cost of the banner will be applied to your fundraising totals. All donations are tax deductible as allowed by law. American Heart Association Tax ID#: 13-5613797
Section 1: Your Information
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email *
example@example.com
Phone Number *
Please enter a valid phone number.
Section 2: Banner Information

Cost of banner is $150
Name on the Banner *
Date of Birth/Passing (if applicable)
Quote or Phrase for banner *
(max: 14 words)
Preferred Payment Method *

Pay by credit card by donating to your personal Heart Walk fundraising page Mail a check to: American Heart Association Heart Walk, 1910 W University Dr. Suite 205, Tempe, AZ 85281
Should be Empty:

Section 1: Your Information