Approved For Release 2001/03/07 :.,CIA-ODP96-00789ROO2100150078-8
    GRILL FLAME VOLUNTEER CONSENT STATEMENT SGFOIA3
    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
    VOLUNTEER
     -RDP96-00789ROO2100150078-8
    Approved For Release A

      Approved For Release 2001/03/07 : CIA-RDP96-00789ROO2100150078-8
                      DATA REQUIRED 13Y rJ'111E PR@IVACY ACT OF 1974
                                     (5 U.S.C. 552a)
      1. Autllcrity: National Records Act, 44 U.S.C. 3102; E.O. 9397, Numbering
      Systen, I'or Feeleral Accounts Rel.ating to Individual Persons, November 22, 194'
      2. PrinciDal Purpose: To maintain a record of' -those individuals who h@ave
      or have hrtd access to GRILL'FLAME information throuLh the use of -their name
      and/or 'Social Securitlv Nim-,ber.
      3. Routine Uses: 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
      volunt@,rv basis, but withholding information will render it i ossible to
                                                 ko
      grant an individual access -to or partioipation in -the Program.
      Approved For Release 2001/03/07 : CIA-RDP96-00789ROO2100150078-8