Approved For Release 1: DP96-00789ROO2100150053-5
       SGFOIA3
       GRILL FLAME VOLUNTEER CONSENT STATEMENT
       1 4) SSAN
       having attained my eighteenth (18th) birthday and otherwise having tull
       capacity to consent, do hereby volunteer to participate in GRILL FLAME, a DOD
       project to determine possible military applications of inherent psychic
       abilities. The following items have been explained to me by ff
       Ar,&;f-e- PQ and are set forth on the reverse side of this Agreement,
       which I have initialed:
            a. The nature, duration, purposes, and expected benefits of the program
       in which I will be participating;
            b. The methods and means by which the program is to be conducted; any
       methods and means that are experimental will be identified as such;
            c. The inconveniences, hazards, discomforts, risks or other effects on
       my health or person which may possibly come from my participation in the
       program; and
            d. The alternative procedures, if any, that might be employed to protect
       further'my health and well-being. I have been given an opportunity to ask
       questions concerning this project and any such questions have been answered
       to my full and complete satisfaction. I understand that I may at any time
       during the course of this project revoke my consent and withdraw from the
       study without prejudice; however, I may be requested to undergo certain
       further examinations, if, in the opinion of a qualified physician, such
       examinations are necessary for my health or well-being.
       (NAME) (DATE)
       I was present during the explanation referred to above, as well as the
       volunteer's opportunity for questions, and hereby witness his/her signature.
       I am not a participant in the GRILL FLAME program.
       (NAME) (DATE)
       CLASSIFIED BY: MSG, DAMI-ISH
       REVIEW ON: APRIL 2000
       SEC"RET
       NOT RELEASABLE TO FOREIGN NATIO
       Approved For Release 2001/03/07 : CIA-RDP96- filb*ME

        Approved For Release 20&E'C:F&TP96-00789ROO2100150053-5
        1. Explanation of experiments, including nature, duration, purpose and
        expected benefits. Must include statement that no hypnosis, drugs, or other
        psychopharmacological agents, or treatment of research subjects by subliminal
        technologies or other means of stimulation unknown to them, are involved in
        this program. (Standard)@@@
        2. Explanation of procedures, including methods and means by which conducted
        and an indication of those methods and means that are experimental -,_A@
        3. Description of reasonably expected inconveniences, hazards, discomfort,
        risks, or other effects. (Standard)
        4. Description of any alternative procedures that might be employed to pro-
        tect further the subject's health. If none, so.state. (StandardPF-1i
        5. Description of alternative advantages to volunteer. (Standardl,@V_
        6. Status of volunteer's health as determined by a physician.,@;@(__:_
        7. You may lose the esteem or respect from certain colleagues because of the
        nature of GRILL FLAME activities since some may consider participation in
        such activities as indicating a belief in the "occult or magical." To our
        knowledge, no-one has suffered such career damage from a GRXLL FLAME r ated
        activity, but the potential for such is brought to your attentio
        8. 1 understand that as a participant in the GRILL FLAME program, I may come
        to believe that I have the ability to use "psychic powers" for personal pro-
        fit in risk-taking situations such as "games of chance" or speculative invest-
        ment. Any such assumption on my part is my sole responsibility. The GRILL
        FLAME program in no way sanctions such an assumption. Some individuals who
        have served as subjects in this kind of experiment have acted on such
        assumptions to their apparent disadvantage. Thus, the risk exists that you
        may come to believe that you have a power that you do not possess. You are
        advised of this risk and warned that you assume responsibility for any
        assumptions which you make about your personal powers or capabilities.
                                     9. Questions posed by volunteer and answers.
        1@
        NOTE: Volunteer will initial end of each of above paragraphs.
        #--To
        SECRt I
        ELEASABLE TO FOREIGN NATIONALS
        Approved For Release 20005/07: CIA-RDP96-00789ROO21001,500,53-5