American Heart Association Memorial Donation - Step 1

Memorial Donation - Step 1 - Acknowledgement Information

*Marked values are required.

Step 1 of 3

Who would you like to remember?

Please tell us about the person you would like to remember. This information will appear on the acknowledgement.

Title
First Name*
Middle Name
Last Name*

Who would you like to receive the acknowledgement?

The American Heart Association will process a personal note acknowledging your gift, to the person(s) of your choice, within 24 - 48 hours. After filling out the form below, you can preview the note by clicking the "Preview Acknowledgement" button.

First Name*
Middle Name
Last Name*
Country*
Email
Address Line 1*
Address Line 2
Address Line 3
City*
State is only required of US and Canada. Use Address 3 field if your state does not appear in the list below.
State/Province
ZIP/Postal Code*

Your Name On Acknowledgement

Please tell us how you would like your name to appear on the acknowledgement and create a personalized message. If you wish, you can choose from one of our pre-written messages or personalize one of the pre-written messages in the text box below.

From
Pre-written Message

Personalized Message
Limit your personal message to 2 or 3 lines (255 characters) to prevent your message from being cut off on the Acknowledgement. Do not use special characters such as #, $, or & as they will harm the printing of your note.

Review acknowledgement or move on to the next step

Please review the acknowledgement by clicking on the "Preview Acknowledgement" button. It is important that the information be accurate to ensure proper delivery. If you are satisfied with the note you can use the "Next" button to move to the next step in the memorial process.