CIA-RDP96-00789R002100150078-8

Approved For Release 2001/03/07 : CIA-RDP96-00789R002100150078-8
SGFOIA3
GRILL FLAME VOLUNTEER CONSENT STATEMENT
I,
NANCY
NAME
K. STOUT.
SOAN
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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
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that the purpose of this training is to teach me how to discipline my
mental perceptive abilities and focus them on data beyond the range of the
five corporal senses.
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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.
WITNESS
Frederick H. Atwater
VOLUNTEER
Panas S. SAout
8 Feb 79
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Approved For Release 2001/03/07 :CIA-RDP96-00789R002100150078-8
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Approved For Release 2001/03/07 : CIA-RDP96-00789R002100150078-8
DATA REQUIRED BY THE PRIVACY ACT OF 1974
(5 U.S.C. 552a)
1. Authority:
National Records Act, 44 U.S.C. 3102; E.O. 9397, Numbering
System for Federal Accounts Relating to Individual Persons, November 22, 1943.
2.
Principal Purpose:
To maintain a record of those individuals who have
or have had access to GRILL FLAME information through the use of their name
and/or Social Security Number.
3.
Routine Uses :
The Social Security Number is to be used to identify the
individual, and the information is to be retained strictly within the Program.
4. Mandatory 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 2001/03/07 : CIA-RDP96-00789R002100150078-8