Notice and Authorization Form

Galex Media Group ("Galex"), a New York City-based video and television production company will be videotaping all weddings performed at The Philadelphia Wedding Chapel ("PWC") the chapel on Friday, April 29, 2016 and Saturday, April 30, 2016, to produce a sizzle reel and/or a television pilot for a potential docu-series featuring the owner and staff of PWC along with couples marrying at there. The reel or pilot may also feature family members of the couples. In producing the reel or pilot, Galex may ask for brief testimonials from the couples and some guests. In addition, following the shoots on April 29 and 30, Galex may look to do follow-up shoots on later dates with some of the couples for potential inclusion in the reel or pilot episode. The content captured on video will be used to pitch the docu-series to television networks but WILL NOT be broadcast or distributed via the internet without your future knowledge or permission.

Name *
Phone *
Authorization *