Approved For Release Sabet RE Toece-oorseroozt001600859-¢ SGFOIA3 GRILL FLAME VOLUNTEER CONSENT STATEMENT M LA Gekono I, LAW mek od, a HARD , SSAN having attained my eighteenth (18th) birthday and otherwise having ru 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 Frederic K 7 i 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. AS IS, (DATE) I was present during the explanation referred to above, as well as the yolunteer's opportunity for questions, and hereby witness his/her signature. I am not a participant in the GRILL FLAME program. CLASSIFIED BY: MSG, DAMI-ISH REVIEW ON: APRIL 2000 SECRET — NOT RELEASABLE TO FOREIGN NATIO Approved For Release 2001/03/07 : ClA-RDP96-ka bobs bods
eee Approved For R elease ope ced: : P96-00789R002100150053-5 1. Explanation of experiments, including nature, duration, purpose and expected penefits. Must include statement that no hypnosis, drugs, OF other psychopharmacologica? agents, OF treatment of research subjects by subliminal technologies or other means ,of stimulation unknown to them, are involved in this program. (standard) 2. Explanation of procedures including methods and means by which co! ducted and an indication of those methods and means that are exper imental yz 3. pescr iption of reasonably expected inconveniences hazards, discomfort, risks, or other effects. (standard) 4. peseription of any alternative procedures that might be employes pro- test further the subject's health. J£ nene, go state. (standard Jaf — 5. pDeseription of alternative advantages tO volunteer - iseanaara 7 6. Status of volunteer 'S health as determined by 4 ohysician. 777 ; 7, You may lose the esteem OF respect from certain colleagues because of the nature of GRILL FLAME activities since some may consider participation in such activities as indicating 4 pelief in the "occult or magical." TO our knowledge» no-one has suffered such career damage from a GRSLL FLAME=r ated activity, put the potential for such ig brought to your attention 8. tL understand that as 4 participant in the GRILL FLAME programs I may come to believe that I have the ability to use "psychic powers" for personal pro- fit in risk-taking situations guch as "games of chance" OF speculative invest- ment. Any such assumption On my part is my sole responsibility. The GRILL FLAME program in no way sanctions such an assumption. some individuals who nave served as subjects in this kind of experiment have acted on such assumptions to their apparent disadvantage. Thus, the risk exists that you may come to believe that you have a power that you do not possess. You are aavised of this risk and warned that you assume responsibility for any assumptions which you make about your personal powers OF capansnicies 27 9. Questions posed by volunteer and answers. PG > NOTE: volunteer will initial end of each of above paragraphs. SECRET Approv proved For Release S08 ee A-RD enn NATIONALS -00789R002100150053-5