CIA-RDP96-00789R002100150075-1

SECRET
Approved For Release 200 1/03/07 ACIA-RDP96-00789R002100150075-1
SGFOIA3
GRILL FLAME VOLUNTEER CONSENT STATEMENT
I,
JOSEPH W. MOMONEAGLE
, SSAN
1
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 LTC WATT/
ILT ATWATER
and are set forth on the reverse side of this Agreement,
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 protect
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 certain
further examinations, if, in the opinion of a qualified physician, such
examinations are necessary for my health or well-being.
(NAME)
19 Febumy 1980
(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.
Gemma Forman
Jorncan
(NAME)
(DATE)
19 Zek 1980
SECRET
Approved For Release 2001/03/
NOT RELEASABLE TOPOLE
NATIONALS
: CIA-RDP96-00789R002100150075-1