Individual Registration for RockingEduTech Conference
This form is to be used by teachers and administrators who plan to attend the conference and want to send a personal check for registration payment.

See our conference website at
Please join us!
Full Name *
Your answer
Email Address *
Your answer
What is your job title? *
Content area and/or grade level
Your answer
School and School Division *
Your answer
Do you require a gluten-free lunch? *
Have you attended our conference before? *
How did you hear about our conference? *
Payment Process *
School or division need an invoice? See
Make checks payable to Rockingham County Public Schools
Mail your check to:

Rockingham County Public Schools
RockingEduTech Conference
c/o Stephanie Failes
100 Mt. Clinton Pike
Harrisonburg, VA 22802

Payment deadline: April 30 (Early Bird rate of $125), June 5 for all other

Contact Stephanie Failes at with questions. Thank you!
Never submit passwords through Google Forms.
This form was created inside of Rockingham County Public Schools. Report Abuse - Terms of Service