Get Your Local Info

Find out what is happening at your local American Heart area
Fundraising Registration for Individuals
Instructions for Completion:
1. Refer to the American Heart Association Individual Fundraising Guidelines.
2. Complete this form.
3. Print a copy for your records.
4. Submit form for approval.

Event Contact Information
First Name*:
Middle Initial:
Last Name*:
Street Address Line 1*:
Street Address Line 2:
Alternate Phone:
Fundraiser Information:
Dates of Fundraiser:(MM/DD/YYYY) to (MM/DD/YYYY)
I want to take advantage of one of your Web-based fundraising tools.
I will plan my event without using a computer and mail a check.


Type of Fundraiser

Auction Email Solicitation Party Sporting Event Car Wash

Heart Sales
Product Sale Yard Sale Party

Basic concept of fundraiser:
Estimated Income:
Will other charities receive a portion of the income? Yes No
If so, which charities?
Have you contacted a local American Heart Association office? Yes No
If so, city where office resides:
Name of person you spoke to:

Why did you choose to conduct your fundraiser for the American Heart Association?

I accept the above indemnification


* Required Fields