Register for Winter Open House

Please provide the following information. * Denotes Required Field
Date:	January 21, 2013
*Title:
*First name:
*Last name:
*Mailing Address:
*City:
State:
Zip/Postal Code:
*E-mail:
*Telephone:
Cell Phone:
Current School:
Graduation Year:
Planned Enrollment Year:
Planned Enrollment Term:
Academic Interests :	(List in order of importance to you)
1:
2:
3:
Athletic and Extracurricular Interests:	(List in order of importance to you)
1:
2:
3:
Number Attending Lunch:
Registration begins at 8:00 a.m. Activities will conclude at 4:00 p.m. If you will be arriving or departing at another time, please indicate:

FOR HIGH SCHOOL SENIORS AND TRANSFER STUDENTS:
Are there any other appointments you would like us to arrange for you?:	Admission Counselor
	Athletic Coach
	Sport(s):
	Scholarship Auditions or Portfolio Presentations:
	Art Dance Music Theatre Design Theatre Performance
	If you selected music, please indicate instrument or vocal part:
If you have questions about the program, need assistance in planning your travel, or will need transportation to or from the Amtrak station in Galesburg or from the Moline or Peoria airports to the Knox campus, please contact the Knox College Office of Admission at 800-678-KNOX or e-mail admission@knox.edu.