Xerox Executive Speaker Request
To request a Xerox executive to speak at your event or participate on a panel or roundtable, please complete and submit the form below. We will reply to you shortly.
 - campi obbligatori
Speaker Information
Requested Speaker 
Other Speaker: 
Type of Request 
Your Contact Information
Nome 
Cognome 
Organization 
Titolo 
Indirizzo e-mail 
Street Address 1 
Street Address 2 
Città 
County 
Postal / ZIP Code 
Paese 
Telefono 
Fax 
 
Event Information
Event Name 
Event Sponsor(s) 
Website for Event 
Date of Event (Month) 
Date of Event (Day) 
Date of Event (Year) 
Event Location (City, Country, Venue) 
Time Event Starts 
Please describe the event 
Please describe the event audience
(e.g., Job Titles, Profession and/or Industry) 
Audience size 
Will the media be invited?
No
If yes, which media will be invited?
Who else will be speaking at the event?
(Name, Title, Organization) 
Who has spoken at the event in the past?
(Name, Title, Organization) 
Please review your information before submitting.
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