Approved For Release 2001/03107': C IAIRDP96-00789 ROO 2100150074-2
   GRILL FLAME VOLUNTEER CONSENT STATEMENT SGFOIA3
        TOSEPR UJ, tkCA40JE_A(;LE_,
   NAME
   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
   nNTEER
   Approved F or-Release C IA-RD P96 -00789 ROO 2100150074-2

   Approved For Release 2001/03/07 : CIA-RDP96-00789ROO2100150074-2
                DATA BEQUIRED BY @JPHE PP'FVACY ACT oi;, :Lg'(4
                                (5 U.S.C. 552a)
   1. Aut-hority: 'luational Records Act,.411 U.S.C. 3102; E.O. 9397, Nuinbering
   System _-Por Federal Accounts rxelating to Individual Persons, November 22, 19113.
   2. Pr-incipal Puri)ose: To maintain a record of' those individuals who have
   or hrore had access to GRILL'FLIU4F, information through the use of their name
   and/or C?0(24 al Securit,, Number.
   3. Rcutine 1.1,3es :The Social Security Number is to be used to identify the.
   individual, and the information is to be retained strictly within the Program.
   4. Manditory or Voluntary Disclosure: Information is disclosed on a
   volzu,tary baSis, but withholding information will. render it impossible to
   grant an individual access -to or participation in -the Program.
   U
   Approved For Release 2001/03/07 : CIA-RDP96-00789ROO2100150074-2