Approved For Release 2001'10'3'/07': &JA-RDP96-00789R002100150050-8
 GRILL FLAME VOLUNTEER CONSENT STATEMENT SGFOIA3
 InavI& c, 1@,Itcy
    NAME
 bSA.N
 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
 VOLUNTEER
 CIA-RDP96-00789ROO2100150050-8
 s
 Approved For Relea

  Approved For Release 2001/03/07 : CIA-RDP96-00789ROO2100150050-8
                DATA REQUIRED BY @211E PEIVACY ACT' OF 1-9-(4
                               (5 U.S.C. 552a)
  I. Aut-nority: National Records Act,, 101 U.S.C. 3102; E.O. 9397, Niwl)cring
  SYsten' -for Federal Accounts Rol.,-jting to Individual Persons, Noveniber 22, 19113.
  2. Pri-ncl-Dal Purpose: To maintain a record of those individuals who have
  or h*cwe had access to nURILL-FLAME information through the use of their narqo
  and/or OOC4al SeeUyjj@,, N.LUbe
  3. ROUti-e 'Uses: The Social Security Number is to be used to identify the
  individual, and the inforipation is to be retained strictly within the Program.
  4. Mandatory or Voluntary Disclosur rM 0
   .e: Info ati. n is iclo on
  vol"mntury ba-sis, but withholding information will render it impossible to
  grant an individual access to or partic-.1.pation in -the Pro.-rwii.
  Approved For Release 2001103107 : CIA-RDP96-00789ROO2100150050-8