Approved For Release 200,11031 7 CiA.RDP96-00789ROO2100150020-1
     GRILL FLAME VOLUNTEER CONSENT STATEMENT SGFOIA3
     I AN/V Q@I)ILJX14J_
        DJ
     NAME UORA
     volunteer for INSCOM Project Grill Flame. I understand this program involves
     training designed to enhance inherent psychic abilities. I consent to this
     training and willingly volunteer to participate in INSCOM intelligence
     projects using my psychic abilities. I understand this program deals with
     mental perceptive abilities beyond the range of the five corporal senses
     and for this reason an aspect of mental training is involved. I understand
     that the purpose of this training is to teach me how to discipline my
     mental perceptive abilities and focus them on data beyond the range of the
     five corporal senses.
     I understand that as a volunteer I may withdraw from the program at
     any time for any reason. My decision to withdraw from the program will be
     accepted without controversy.
     I understand that for precautionary and screening reasons that I as
     a GRILL FLAME volunteer must have a Class A physical exam to include a
     stress EKG prior to beginning training.
     NOTE: Physical examination taken within the past 12 months is acceptable.
       WITNESS
     7 t--p
     VOLUNTEER
     Approved For Releasekilb-b-114-61f07': CIA-RDP96-00789ROO2100150020-1

       Approved For Release 2001/03/07 : CIA-RDP96-00789ROO2100150020-1
                    DATA REQUIREM BY THE PIMIACY ACT 01' 19'(4
                                 (5 U.S.C. 552a)
       1. Aut-acrity: Nationail Records Art, )14 U.S.C. 3102; E.O. 9397, Nualbering
       ,yster, Cor IFederal Accounts Relating to Individual Pcrsons, Novcniber 22, 1.9113.
       2. Principal Purpose: To niaintain a record of' those individuals who have
       or have had access -to GRILUFLME, inforiTiation through the use of -their narae
       and/or Social Security NLu,,ber.
                  J
       3. Routi,-e -Uses- The Social Security Nutnber is to be used to identify Lhe
       individual, and the inforroation is to be retained strictly within -the Program.
       4. Mandatory or Voluntary Disclosure: Information is disclosed on a
       voluntary basis, but withholding information will render it inTossible to
       grant an individual access to or participation in -the Pro.-rari.
       L
       Approved For Release 2001/03/07 : CIA-RDP96-00789ROO2100150020-1