CIA-RDP96-00789R000100260001-2

Approved For Release 2000/08/08 : CIA-RDP96-00789R000100260001-2
SURVEILLANCE CONSENT AUTHORIZATION
I,
, voluntarily consent to perform duties
as a beacon person for project remote viewing sessions. I understand that as a
beacon person, I will serve as a focus for remote viewers.
In agreeing to this duty, I acknowledge that:
a. My thoughts relevant to the target sites that I am visiting may be
accessed by a remote viewer.
b. My thoughts that are not relevant to the target sites (e.g .; personal
memories) may inadvertantly be accessed by a remote viewer. Should
this occur, such data will be held in strictest confidence and will not
be made part of any formal project records.
I have also been appraised of the following:
a.
This consent can be withdrawn at any time without question or penalty.
b.
This consent will not be construed as authorization to conduct any form
of surveillance without my prior knowledge or consent.
1
This statement of authorization is executed in the presence of the witness on
this
day of
, 19
without reservation,
amendment or restriction and without coercion or implied and/or stated
inducements.//END//
(SIGNATURE)
(DATE)
(WITNESS)
(DATE)
Approved For Release 2000/08/08 : CIA-RDP96-00789R000100260001-2

SG1J
Approved For Release 2000/08/08 : CIA-RDP96-00789R000100260001-2
Approved For Release 2000/08/08 : CIA-RDP96-00789R000100260001-2