Approved For Release 2000/08/08
: CIA-RDP96-00789R0026001 60009-8
STATEMENT OF CONSENT
INSCOM CENTER LANE PROJECT PARTICIPANT
lAGPA-F-SD
1.
f S/CT.-A/NOFORNl
I.
voluntarily accept assignment
to the INSCOM CENTER LANE PROJECT UCLPJ and fully understand that:
a.
(S/CL-l/NOFORN))
The
Army
General
Counsel
has
determined
that
ICLP
constitutes experimentation on human subjects.
As required by Procedure
of DoD
Directive 5240. 1-R, approval for project activities has been
granted by Secretary
of the Army.
b.
(S/CL-3/N0F0RN)
The aim of ICLP is to develop highly skilled personnel who
are
capable
of
conducting
professional
level
intelligence/counterintelligence
operations
through
use
of
psychoenergetic
methodology.
Development
of
ICLP
personnel will be accomplished with special training based on mission requirements.
c.
(C/NOFORN)
Assignments
in ICLP are governed by the sensitivity and degree
of expertise required for the position.
I will be assigned in accordance with my
capabilities and experience,
regardless
of my rank
or previous position.
Due
to
the nature of training involved,
the duration of my participation
is
indefinite.
Records of my
involvement will be available
to project personnel,
but
otherwise
protected under project security measures.
d.
(C/NOFORN)
The
primary
consideration
in
any
career
development
or
assignment action will be ICLP mission and operational requirements.
I understand
that exemption,
interruption,
or delay in normal career deyelopnent
patterns --such
as branch schooling and assignment
opportunities- -may
prejudice
future
promotion
and assignment potential.
I have been assured, however,
that every effort will be
made to preclude the adverse effects listed above on my career.
2.
(S/CL-3/N0F0RN)
PSYCHOENERGETICS
(PE)
include
various
processes
by
which
individuals psychically interact with objects,
locations, and organisms.
a.
(S/CL-l/NOFORN)
I understand that while there
is no demonstrated
risk
of
permanent or temporary injury
(including physical,
psychological and/or damage
to
participants'
reputation)
to project personnel beyond risks
to which
they would
ordinarily be exposed in their daily lives,
the potential
for
injury during some
training cannot be conclusively ruled out.
WARNING NOTICE:
CENTER LANE SPECIAL ACCESS PROGRAM
RESTRICT DISSEMINATION TO THOSE WITH VERIFIED ACCESS
CATEGORY CL -4
NOT RELEASEABLE TO FOREIGN NATIONALS
CLASSIFIED BY:
CDR,
INSCOM
DECL:
OADR
Approved For Release 2000/08/08
: CIA-RDP96-00789R0026001 60009-8
Approved For Release 2000/08/08
: CIA-RDP96-00789R002600160009<8
b.
(S/CL-l/NOFORN)
I may temporarily choose
not
to perform PE
at
specific
times!
or
permanently
discontinue
participation
without
prejudicial
effect
.
Termination will be affected by notifying the
ICLP Manager
or
in his absence,
his
designated acting ICLP Manager.
3.
(S/CL-3/N0F0RN)
As a participant
in ICLP, and lAW AR 381-17,
I consent
to tape
recording, monitoring and transcribing of all
operational and
training
interviews
in which
I am involved as an integral part of the
ICLP mission. /
these recordings are subject to being monitored and/or transcribed by third parties
not otherwise involved
in operations or
training.
I waive any claim or
right
of
ownership to all
tape recordings and transcripts made
in conjunction with
ICLP,
with the understanding that these tape recordings and transcripts
are property
ot
the United States Government.
4.
(S/CL-3/N0F0RN)
I
further
consent
to
participate
in
any
nonintmsive
biomonitoring activities that are necessary for project mission accomplishment.
5.
(U)
I hereby acknowledge receiving formal counseling concerning my assignment
to ICLP.
Basic operational and training procedures
(both
’^o’JCine and experimental
J
and their purposes, as well as attendant discomforts, risks, and benefits have been
explained to me.
I understand that
I may at any time ask questions
of
project
personnel
relating
to
areas
unclear
to
me.
I
further
understand
that
my
participation in ICLP
is voluntary and
that at my request
I may at any time be
reassigned without fear of adverse personnel action.
Signature:
Signature:
Approved For Release 2000/08/08
: CIA-RDP96-00789R0026001 60009-8