Approved For Release 200j1,QW0,7,- Cl -RDP96-00789ROO2100150065-2
      DATE: K ELZ6 Z9
      GRILL FLAME VOLUNTEER SECURITY AGREEMENT
      SGFOIA3
      1. (U) 1, 3) 6 tj @tc j2 Z @ ,@y - , SSAN:
      understand that the-highly sensitive and classifiect 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.
      11. (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:
      RANIC/GRADE
      741) /0 0
      UNIT/OF/GANI2
           Z-t-@-@ 724-76 iT--
      POSITION .
      SIGNED:
                         44
      NAME, RANK/GRADE
      _rrpz)l .-@ T-A C-
      UNIT/ORGANIZATION
      -:17AJ7-C-YeP1eE:-7ZFR
      POSITION
      Approved For Release QQyoV07,: CIA-RDP96-00789ROO2100150065-2

      
       Approved For Release 2001103107 : CIA-RDP96-00789ROO2100150065-2
              DATA lis'l',QUIRED BY 9''11E PR@T@7ACY ACT Oli' lq,r)@
                                 (5 U.S.C. 552a)
             L
       1. Auth.ority: 11fationa" Records Act, 44 u.s.c. 3102; E.O. 9397, Nlunberinr
       System 'for I@edcrfti AC -
       coants Relating to Individual Persons, Njovember 22, 1943-
       2. Princ-11-Dal Pu-vT)ose: To maintain a record of' those individuals who have
       or have had access to GRILL'FLA14E inforiwation through the use of their name
       and/or Soci-,I- Security Number.
                  J
       3. Routine 'Uloe3: 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.
       U
       Approved For Release 2001/03107 : CIA-RDP96-00789ROO2100150065-2