Make check payable to, and send to:

 Premier Sports, 401 Charmel Place, Columbus, OH 43235

Amount enclosed:  _________         (No refunds or transfers)

Event:                  _____  Marathon    _____ 1/2 Marathon    _____ 5K    _____ 10K

___ 2 Person Relay    ___ 3 Person Relay    ___ 4 Person Relay   ___ 5 Person Relay

Email: ______________________________________________   

Age as of 2/17/08:  _______       Gender:   M  / F

Windshirt:   S      M     L      XL      XX

Name: ______________________________________________        

Address: _________________________________________________________________

City: ___________________  St:  ____   Zip: _______

Phone: ______________________

Waiver:  I agree that by participating in this physical activity,  the "Last Chance for Boston" Marathon (the “Event”) or use any Event facility/premises, I do so at my own risk.  I assume all risk of injury, illness, damage or loss to me or my property that might result, including without limitation, any loss or theft of personal property.  I consent to medical treatment in the event of injury, accident and/or illness during the Event.  I agree on behalf of myself (and my personal representatives, heirs, executors, administrators, agents and assigns) to release and discharge Premier Sports,  the City of Dublin, and all other event sponsors, associates and volunteers from any and all claims or causes of action (known or unknown) arising out of their negligence.  I acknowledge that I have carefully read this Waiver and Release and fully understand that it is a release of liability.  By my signature below, I am waiving any right that I may have to bring legal action to assert a claim against any and all Event sponsors and representatives for their negligence.

Signature:_____________________________________________________

(Parent/Guardian if participant under 18 years of age)              Date