Approved For Release 2001-LOZ/07,~.:,41A.RDP96-00789ROO2100150021 -0
 DATE:
 GRILL FLAME VOLUNTEER SECURITY AGREEMENT SGFOIA3
 1. (U) I, ,41AI T
 --,D@j-1P1y7191V , SSAN:
 understand that the highly sensitive and classifi Toll T 1177=07
 am about to receive as part of the GRILL FLAME, Program.belongs to the
 United States Government. I understand that disclosure of this information
 is punishable under Title 18, Section 798, u.s.c. "Disclosure of Classified
 Information," June 1948 as amended.
 2. (U) I do solemnly swear that I will never divulge, publish, or reveal
 by word, conduct, or by any other means GRILL FLAME classified information
 or knowledge, except in the performance of my official duties, and as
 specifically authorized in writing in each case by the appropriate agency
 P
 of the United States Government.
 3. (U) I understand that no change in my assignment or employment will
 relieve me of my obligation under this agreement and that the provisions
 of this agreement will remain binding upon me even after the termination
 of my services with the United States Government.
 4. (S) I take this obligation of my own free will, without any mental
 reservation or purpose of evasion. I understand that as a GRILL FLAME
 volunteer the fact that I possess psychic abilities is classified and I
 cannot divulge this fact by word, conduct, or by any other means.
 WITNESS:
 NAME, RANK/GAADE
     @Oe,@ /
 1;11-T
 UNIT/ORGANIZATTON
 SIGNED:
 NAME, !RANK/G#An'
  //V 5 ee) Al
 //Po //
 UNIT/ORGANIZATION
   POSITION 'POSITION
 Approved For Release 9QIJ;3197,@: CIA-RDP96-00789ROO2100150021-0

         Approved For Release 2001/03/07 : CIA-RDP96-00789ROO2100150021-0
                   DATA EEQUIREM BY ri''HE P13TVACY ACT' OF 19'(4
                                   (5 U.S.C. 552a)
         I - Autl-)ority: Ttationaj-,@ Records Act, 44 U-S'.C. 3102; E.O. 9397, Numberin
         System -for I@ccounts Relating to Individual Persons, November 22, 19113.
         2. Princilpal TPurDose: To niaintain a record of those individuals who have
         or have had accesG to GRILL*FLPd4E inform,@ction through the use of their narne
         and/or Soc4---l Security Ntmber.
         3. Routine "I'sest The Social Security Number is to be used to identify the
         individual, and the infornation is to be retained strictly within 'the Program.
         4. Mandatory or Voluntary Disclosure: Information is disclosed on a
         voluntary basis, but withholding information will re@nder it intpossible to
         grant an individual access to or participation in the Pro.rfrani.
         Approved For Release 2001103107 : CIA-RDP96-00789ROO2100150021 -0