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.
 - campos obrigatórios
Speaker Information
Requested Speaker 
Other Speaker: 
Type of Request 
Your Contact Information
Primeiro Nome 
Último Nome 
Organization 
Cargo 
Endereço de e-mail 
Street Address 1 
Street Address 2 
Localidade 
Estado 
Postal / ZIP Code 
País 
Telefone 
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?
SimNão
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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