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.
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Speaker Information
Requested Speaker 
Other Speaker: 
Type of Request 
Your Contact Information
First Name 
Last Name 
Organization 
Title 
Email Address 
Street Address 1 
Street Address 2 
City 
State 
Postal / ZIP Code 
Country 
Phone 
Fax 
Promotional Email
I would like to receive promotional email from Xerox about the following:
(please select to indicate your areas of interest)
 
 
 
 
 
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?
YesNo
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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