SECR cy Approved For Releas#-2064) RAG RDP96-00789R002100150013-9 GRILL FLAME VOLUNTEER CONSENT STATEMENT SGFOIA3 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 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; ee 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 guestions 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. — iS , WF FA (NAME) (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. (NAME) (DATE) SECRET Approved For Reléase 2001/03/07 ~CIA-RDP96-00789R002100150013-9
= (fr Approved For Release 20010a18e Lor A-RQE d-00789R002100150013-9 1. Explanation of experiments, including nature, duration, purpose and expected benefits. Must include statement that no hypnogis, drugs, or other psychopharmacological agents, or treatment o£ research subjects by subliminal technologies or other means, of stimulation unknown to them, are involved in this program. (Standara) J} 2. Explanation of procedures, including methods and means by which conducted and an indication of those methods and means that are experimental. | 3. Description of reasonably expected inconveniences, hazards, discomfort, risks, or other effects. (Standard) See Description of any alternative procedures that might| be employed,to pro- tegt further the subject's health. If none, so state. (Standard) £% 5. Description of alternative advantages to volunteer. (standard) f 6. Status of volunteer's health as determined by a physician. Include EKG results. 7. You may lose the esteem or respect from certain colleagues because of the nature of GRILL FLAME activities since some may consider participation in such activities as indicating a belief in the “occult or|/ magical." To our knowledge, no-one has suffered such career damage from aj GRELL FLAME-related activity, but the potential for such is brought to your Attention. 8. I understand that as a participant in the GRILL FLAME program, I may come to believe that I have the ability to use “psychic powers" for personal pro- fit in risk-taking situations such as "games of chance” pr speculative invest- ment. Any such assumption on my part is my sole responsfibility. The GRILL _ FLAME program in no way sanctions such an assumption. Some individuals who have served as subjects in this kind of experiment have acted on such assumptions to their apparent disadvantage. Thus, the rlisk exists that you IMay come to believe that you have a power that you do not possess. You are advised of this risk and warned that you assume responsibility for any assumptions which you make about your personal powers or capabilities 9. Questions posed by volunteer and ansvers ff NOTE: Volunteer will initial end of each of above paragraphs. SECRET Approved For Relea$é"2664703187": QARBDP9E46789R002100150013-9