Approved For Release 2001/0310.7,-1.. -CIA,-;R6P96-00789ROO2100150073-3
      DATE: 8 PF 6
      GRILL FLAME VOLUNTEER SECURITY AGREEMENT SGFOIA3
      I. (u) I, Vbsc-p4 (.,), pkqtx0jjF7Ac, C_E-- , SSAN:
      understand that the highly sensitive and classified
                      information I have or
      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
      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/GRADE
           7
      UNIT/ORGANIZATION
      POSITION
      SIGNED:
      N PANK/GRADE
           !qoege
      @ @S@ ,
      UNIT/ORGAgIZATION
             C@
      POSIVION
      Approved For Release 200~q3~0,7~,~,~C~A-RDP96-00789ROO2100150073-3

      Approved For Release 2001/03/07 : CIA-RDP96-00789ROO2100150073-3
                   DATA KEQUIRED BY @.'IIE I'l)"WACY ACT OF 19'T4
                                   (5 U.S.C. 552a)
      1. Put'nority: National Records Act@ 44 U.S.C. 3102; E.O. 9397, Munbering
      Systen. afor. Fe@Iernl Ac,ounts Relating to Individual Persons, Ilovember 22, 19113.
      2. Princinal Purpose: To maintain a record of' those individuals who have
      or have had access to GRILL*FLAKE information through the use of -their name
      and/or Social Securit- Kumber.
                  0
      3. Routi-e Uses: The Social Security Number is -to be used to identify the
      individual, and the information is to be ret-ained strictly within the Program.
      4. Mand,.itory or Voluntary Disclosure: Information is disclosed on a
      voluntary basis, but with@olding information will render it impossible to
      grant an individual access to or participation in -the Prograpi.
      Approved For Release 2001/03/07 : CIA-RDP96-00789ROO2100150073-3