C % "I=A-~iDP96-00789ROO2100150075-1
    Approved For Release f2o
                                 SGFOIA3
    GRILL FLAME VOLUNTEER CONSENT STATEMENT
    I STP-S "to. SSAN
    having attained my eighteenth (18th) birthday and otherwise having full
    capacity to consent, do hereby volunteer to participate in GRILL FLAME, a DOD
    project to determine possible military applications of inherent psychic
    abilities. The following items have been explained to me by I-M 14-J.4
         Ar.4"19L and are set forth on the reverse side of this Agreeme5@_
    which i have initialed:
         a. The nature, duration, purposes, and expected benefits of the program
    in which I will be participating;
         b. The methods and means by which the program is to be conducted; any
    methods and means that are experimental will be identified as such;
         C. The inconveniences, hazards, discomforts, risks or other effects on
    my health or person which may possibly come from my participation in the
    program; and
         d. The alternative procedures, if any, that might be employed to prote ct
    further my health and well-being. I have been given an opportunity to ask
    questions concerning this project and any such questions have been answered
    to my full and complete satisfaction. I understand that I may at any time
    during the course of this project revoke my consent and withdraw from the
    study without prejudice; however, I may be requested to undergo ce-rCain
    further examinations, if, in the opinion of a qualikfied physician, such
    examinations are necessary for my health or well-being.
         (110
    400, (NAME) '@@DATE)
    I was present during the explanation referred to above, as well as the
    volunteer's opportunity for questions, and hereby witness his/her signature.
    I am not a participant in the GRILL FLAME program.
    (NAME) (DATE)
    Sf,), E P R" E I
    NQ@eJELEASAP=
    Approved For ease -2UU1 T63truLlaE:Idf,~-4~ffi~;k-SO0789ROO2100150075-1