Approved For Release 2K&149@W-O7-f, - 91A,-RDP96-00789ROO2100150057-1
  DAI E-
  GRILL FLAME VOLUNTEER SECURITY AGREEMENT SGFOIA3
  1        lVe0-           C, /(A   
  (U) 1    J               @Q       
           414ler          SSN      
                                    

  .        7                        .
  9        ,                        
                                    

  understandthat the highly          classified intormation i have or
           sensitive and            
                                    

  am about receive as [)artthe GRILLFLAME Program belongs to the Uni.ted
  to       of                       States
                                    

  Government.I understand    disclosureof this information is punishable
           that                     under
                                    

  Title    ection 790, U.S.C."Disclosureof Classified Information," June
  16, S                             1940 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.dutiesp 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
  A/',
  71770-ff@-ANIZATION
  M
   I
  go-/OV
  .7-
  P LRS-11n@
  SIGNED:
    -7
  NAME, R /GRADE
  *AW9 4R7@
   ee, 0 &1L5,-4j@VSe21)1tj e.01tAV-5 lqldP
  UN-IT/O-RGANIZATION
          -
  PUSITLUN
                       t
  Approved For Release 2 [411k%RPP96-00789ROO2100150057-1
  wo 1 La V,

  
           Approved For Release 2001/03/07 : CIA-RDP96-00789ROO2100150057-1
                        DATA REQUIRED BY THE PRIVACY ACT OF 1974
                                     (5 U.S.C. 552a)
           1. Authority: National Records Act, 44 U.S.C. 3102; E.O. 9397, Numbering
           System for Federal Accounts Relating to Individual Persons, November 22, 1943.
           2. Principal Purpose: To maintain a record of those individuals who have
           or have had access to GRILL FLAME information t.hrOUgh the use of their flame
           and/or Social Security Number.
           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. Mandatory or Voluntary Disclosure: Information is disclosed on a
           Voluntary basis, 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-RDP96-00789ROO2100150057-1