GRILL FLAME VOLUNTEER SECURITY STATEMENT

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00789R002100150014-8
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 2
• Document Creation Date: November 4, 2016
• Document Release Date: December 4, 1998
• Sequence Number: 14
• Publication Date: October 4, 1977
• Content Type: CONT

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Approved For Release.2001/03/(~~,4 ?~~~RDIP96-007898002100150014-8
DATE: ^
GRILL FLAME VOLUNTEER SECURITY AGREEMENT
SGFOIA3
1. (U ) I /~~~.~_~ ) ~"f ~J ~ u l~r rz> , ssAN
understand that the highly sensitive and classifie ~.n~orma i
am about to receive as part of the GRILL FLAME Program belongs to the
United States Government. I understand that disclosure of this information
is punishable under Title la, Section 798, U.S.C. "Disclosure of Classified
Information," June 19+8 as amended.
2. (U) I do solemnly swear that I will never divulge, publish, or reveal
by ward, conduct, or by any other means GRILL FLAME classified information
or knowledge, except in the performance of my official duties, and as
specifically authorized in writing in each case by the appropriate agency
of the United States Government.
3. (U) I understand that no change in my assignment or employment will
relieve me of my obligation under this agreement and that the provisions
of this agreement will remain binding upon me even after the termination
of my. services with the United States Government.
1+.-(S) I take this obligation of my own free will, without any mental
reservation or purpose of evasion. I understand that as a GRILL FLAME
volunteer the fact that I possess psychic abilities is classified and I
cannot divulge this fact by word, conduct, or by any other means.
NAME, RANK/GRADE
UNIT/ORGANIZATION
SIGNED : :,/-'?C~.zLC~?~tG~dC~.,,~z?~-
NAME , RANK/GRADE
UNIT/ORGANIZATION
POSITION ~ EOSiTION
Approved For Release 2001/03/07 :CIA-RDP96-007898002100150014-8
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 Approved For Release 2001/03/07 :CIA-RDP96-007898002100150014-8
DA`1'A ]t1i,aUlRI~D BY 7']iE PRI~IACX ACT Ol' 19'j~-
(5 U.S.C. 552a)
1. ~?uthority : Platianal Records Act , ~ ZF ti , S . C . 3102 ; E.O. 9397 , Numbering;
System for I~'erlcral ltccounts P,ela.ting to Individual Persons, November 22, 1.9~i3?
2. Prir_cipal Purpose: To maintain a record of those individuals who have
or have had access to GRILL'FLAP~JE information through the use of their name
andlor JOCiwI Secu~-it;" dumber.
3. Routine Uses: mhe Social Security Number is to be used to identify the
individual, and the information is to be retained strictly within the Program.
~+. P~anda.tory or Voluntary Disclosure: Information is disclosed on a
voluntary basis, but withholding information will rer.~der it impossible to
grant ar- individual access to or participation in the Program.
Approved For Release 2001/03/07 :CIA-RDP96-007898002100150014-8