Approved For Release 2001*103IQ7,,.,,QI*-RDP96-00789ROO2100150079-7
  DATE: f C- C?
  GRILL FLAME VOLUNTEER SECURITY AGREEMENT
  (U) I, y S SSAN:
  understand' that the highly sensitive and classifie7 -Lillurmation 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 SGFOIA3
  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.
  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:
  NANE, RANK/GRADE
  SIGNED:
       A&@@, C/A-l ' 4@@
  UNIT/ORGANIZATIOI,r
  -S- <-C)
                                POSITION
  (@P,OSITION
  Approved For Releasi-20@110107 : CIA-RDP96-00789ROO2100150079-7

        -Approved For Release 2001/03/07 : CIA-RDP96-00789ROO2100150079-7
                               DATA REQUIREM BY THE PRIVACY ACT OP 1974
                                    (5 U.S.C. 552a)
        1. Authority: National Records Act:, 44 U.S.C. 3102; E.O. 9397, Dhunbering-
        System for, Federal Accounts Relating to Individual Persons, November 22, 1.9113.
        2. Pri_ncipal PurT)ose* To maintain a record of those individuals who have
        or 'have had access to GRILL'FLM4E information through the usn of -their name
        and/or Social Security M-unber.
        3. R. -_ u - t -_', -,,. ee s :The Social Security Number is to be used to identify the
        individ,aal, and the information is to be retained strictly within the Program.
        4. Hand@qtory 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 2001103107 : CIA-RDP96-00789ROO2100150079-7