Approved For Release 2001103-
       107,;,.(:JA.RDP96-00789ROO2100150062-5
       DATE: rC-I-
       3 .34
       GRILL FLAME VOLUNTEER SECURITY AGREEMENT SGFOIA3
       ,Xj SSAN:
       I. (U) IV
       understand that the highly sensitive and classified informatiun _L nave or
       an 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
       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:
       S-If
       NAME, RANK/GRADE
            L)sAr% I =j_tMSC6 tq
       1?1) / MkC
       UNIT/ ORGANI ZATION
       AA r
       POSITION
       SIGNE
       151E,11 RANKIG ADE
       7G@
       (2) 8 /@) -
       17@q C
       UR_IT/OR@ANIZATIr
       -ZL-6
       POSITION
       Approved For Release 2001/03/07
       ry, r'-~-..CtPi-RDP96-00789ROO2100150062-5

        Approved For Release 2001/03/07: CIA-RDP96-00789ROO2100150062-5
                  DATA BJEQUIRED BY j,im pi-@,'TVACY ACT op, l9ro,
                                   (5 U.S.C. 552a)
        Records Act, 44 U.S.C. 3102; E.O. 9397, Numbering
        _,,,tj@crity: Nationa.
        syste-I -cor reetoral Accounts Pelating to Individual Persons, November 22, 1943.
        2. Principal Purpose, To maintain a record of' tho@,e individuals who have
        or ti-ave had access to GRILUFLA14E information through the use of -their name
        and/or Social Security Number.
        3. Routi-e -Ulses: 11he Social Security Number is to be used. to identify @he_
        individual, and. the information is to be retained strictly within the Program.
        4. Mandatory or Voluntary Disclosure: Information is disclosed an a
        vol-L,n.t.@2,ry bajis, but withholding information will. render it impossible to
        grant an individual access to or participation in -the Program.
        Approved For Release 2001/03/07 : CIA-RDP96-00789ROO2100150062-5