Approved For Release 2004i6iJ07 :61A.RDP96-00789ROO2100150061-6
  GRILL FLAME VOLUNTEER CONSENT STATEMENT SGFOIA3
  NAME
  volunteer for INSCOM Project Grill Flame. I understand this program involves
  training aesigned 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
  r@ental 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
  Approved For Release 20qlb~10,7;1""-"P'ffA-RDP96-00789ROO2100150061-6

          Approved For Release 2001/03/07: CIA-RDP96-00789ROO2100150061-6
                      DATA RE'.QUIRED BY THE PIUVACY ACT OF 1974
                                    (5 U.S.C- 552a)
               AutjjC)rity: Ilationa" Records Act5 U.,,@I.C. 3102; E.O. 9397, Nutabering
          Systen,l for Fe(:er,-.1 Accounts Relatir@g to Individual Persons, Nov(:, ber 22, _9
          2. Princi-Dall Pur-pose: To maintain a record of' those individuals who have
          or have had access to GRILL'FLAIE0 information through the use of -their name
          and/or Social Security Number.
                J
          3. R o,,,. - t i n e 'U, @ e s -The Social Security Number is to be used to identify -the
          individual, and. the information is to be retained strictly within the Program.
          4. Haand,@tory or Voluntary Disclosure: Information is dirclosed on a
          voluntary basi5, but withholding information will render it impossible to
          grant an individual access to or partic-ipation in -the Prot-ram.
          Approved For Release 2001/03/07: CIA-RDP96-00789ROO2100150061-6