Approved For Release 2004/ .03/07 : ~aIA-RDP96-00789ROO2100150064-3
GRILL FLAME VOLUNTEER CONSENT STATEMENT SGFOIA3
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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.
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VOLUNTEER
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4,11fibbiWAY7 : CIA-RDP96-00789ROO2100150064-3
Approved For Relea -7 :1
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      Approved For Release 2001103107 : CIA-RDP96-00789ROO2100150064-3
         DATA 1UP"QUIRED BY THE PRiVACY -ACT OF 19'(4
      (5 U.S.C. 552a) -
      1. Autiiority: i@,ationa, Records Act, )111 U.,S.C. 3102; E.O. 939'T, Nivnbcring
      E - - i
      System f'or Federal Accounts Rclatin[,, to Individual Persons, Koverpber 22, 19113.
      2. Princ-1-plall Purwse: To maintain a record of' those individuals who have
      or have had access to GRILL-FM4E information through the use of -their nam,.,@
      and/or Fociai Security Dftmber.
      ly
      3. Routine Uses: The Social Security Nimber is to be used to identify the
      individual, and. the information is to be retained strictly within -the Program.
      4. Mandentory or Vol-antary Disclosure: Information is disclosed on a
      voluntary basis, but withbolding information will render it inkpossible to
      grant an individual access -to or -participation in -the Pro.,frmi.
      Approved For Release 2001103107 : CIA-RDP96-00789ROO2100150064-3