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November 4, 2016
Document Release Date: 
December 4, 1998
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PDF icon CIA-RDP96-00789R002100150068-9.pdf64.75 KB
r -. ? i F, . r.., Approved For Release 2001/0~~07 :CIA-~DP96-007898002100150068-9 GRILL FLAME VOLi7NTEER CONSENT STATEMENT S G F OIA3 NAME N 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 Yiow 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. Approved For Release 200 :f~31d.`~~`~~ ~ -RDP96-007898002100150068-9 ,R ', I Approved For Release 2001/03/07 :CIA-RDP96-007898002100150068-9 1)A~.1'A RJsG~UlRI?I) BY TTTF PRT~I)`,CY 11C'I' Ol'' 197+ (5 U.S.C. 552x) 1. ~!uth.ority : PTatioi:al Records pct , 1ElF U . S . C . 3102_ ; I;. U . 939'7 , Numbering Systerri fo.~ Federal Ilccounts Relating to Individual Pei?sans, I~Tovember 22, 1.9~F3. 2. Principal Purpose: To rr~aintain a record of those individuals who have or have had access to GI?ILL' FLl1T~ inform~.~tion through the use of their name and/or Socwc.l Security PJumUer. 3. T?outine Uses : The Social Security Tlumbe.r i.s to be used to identify the individual, and. the information is to be retained strictly within 'the Program. ~+. t4anda.tory or Voluntary I)iscl.osure: Information is disclosed on a vol~..ntary basis, but withholczirig information wi1.1. render it impossible to grant ~.n ind.ividual access to or par tici~ation in the P.rog,.ra.rn. Approved For Release 2001/03/07 :CIA-RDP96-007898002100150068-9