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.
 - requerido
Speaker Information
Requested Speaker 
Other Speaker: 
Type of Request 
Your Contact Information
Nombre 
Apellido 
Organization 
Título 
Dirección de correo electrónico 
Street Address 1 
Street Address 2 
Ciudad 
Estado 
Postal / ZIP Code 
País 
Teléfono 
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.