Approved For Release 2001/01107:, ClAADP96-00789R002100150068-9
      GRILL FLAME VOLUNTEER CONSENT STATEMENT
      NAME
      SGFOIA3
      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.
      @W;, @_Ss
      VOLUNTEER
      Approved For ReJease 200~-'16-VO.-7,-~ll"CIA-RDP96-00789ROO2100150068-9

     Approved For Release 2001/03/07 : CIA-RDP96-00789ROO2100150068-9
                   DATA REQUIRIM BY 9''IIE PRIVACY ACT OF 1974
                                 (5 U.S.C. 552a)
     1. Puthority: National Records Act, 44 U.S.C. 3102; E.O. 9397, NibiabexinF
     Syste-m for Federal Accounts Relating to Individual Persons, November 22, IC9113.
     2. Prirci-oa-I Pur-oose: To riaintain arecord of those individuals who have
     or 'have had access to GRILUFLAME information through the use of -their name
     and/or Soci.al Security Nurber.
               ly
     3. Ro-Lfti-e "'Ises: The Social Security Uumber is to be used to identify the
     individual, and. the infornation is -to be retained strictly within -the Program.
     4. Mandatory or Voluntary Disclosure: Information is disclosed on a
     vol-,,.ntary ba-s-is, but withholding information will ronder it impossible to
     grant an individual access to or particj.@ation in -the Program.
     Approved For Release 2001/03/07 : CIA-RDP96-00789ROO2100150068-9