GRILL FLAME VOLUNTEER CONSENT STATEMENT (LAWRENCE J. RICKARD)

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00789R002100150053-5
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 2
• Document Creation Date: November 4, 2016
• Document Release Date: December 4, 1998
• Sequence Number: 53
• Publication Date: March 23, 1981
• Content Type: CONT

A roved For Release DP96-007898002100150053-5
pp
SGFOIA3
GRILL FLAME VOLUNTEER CONSENT STATEMENT
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 ~,-e~~~~~~~ ~-
~~,~~~~ ~ and are set forth on the reverse side of this Agreement,
which I have initialed:
I ~.~ bt//c~Cit/ ~ dz V ~ ~l / c'- f~ fI ~~ --- ~ SSAN
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.
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 j
SECRET
~'1G~-e~
(DATE)
CLASSIFIED BY: MSG, DAMI-ISH
REVIEW ON: APRIL 2000
NUT RELEASABLE TO FOREIGN NATIO
Approved For Release 2001/03/07 :CIA-RDP96- ~(~1~Q~Fj
 __.,R- Approved For Release 2
~(~-: DP96-007898002100150053-5
duration, Purpose and
including nature, drugs, or other
eriments, -that no hypnosis,
.1. Explanation of E;Xp subjects by subliminal
expected benefits. Must include statement are involved in
ical agents, or treatment of research
psychopharmacolo~ther means of stimulation unknown to them,
?r
technologies
Standard)- ducted
this program. ( which co
including methods and meaneYbmental.
Explanation of procedures, that are eXp
of those methods and means
comfort,
i
~?
d
s
idiation
nc and an hazardse
of reasonably expected inconveniences,
scription
dard)o~
~
De
Stan
3. risks, or .other effects. (
that might be employed to pro-
alternative procedures 5tandard~~~
tion of any so state.
Q. Descrip If none,
ubject's health.
d --
the s
dar
te~.t further Stan tion of alternative advantages to volunteer. (
5~ Descrip a hy~ician.~~~--~
ined by P
determ
of volunteer's health as
tus
Sta he
6.
act from certain colleagues because of
or rasp consider participation in
7. You may lose the esteem "occult or magical:." To our
E activities since some may GRIGLL FLAME', ated
nature of GRILL FLAMndicating a belief in the a from a ~,,G~~~
such activities as brought to your attention ~~~'
ssuch iseer damag
~~
no-one has
e
d
r
,
g
kne
for
owle
l
ia of I may come
activi{cy~ but the P the GRILL FLAME Program,
articipant'in " for personal pro'
8. I understand that as a P to use "psychic Power or speculative invest-
" ames of chance The GRILL
to believe that I hsituati nsisuch as g sole responsibility.
fit in risk-taking tion on my part is mY tion. Some individuals who
ment. Any such assume
rogram in no way sanctions such an assum
FLAME P in this kind of expeYiment have acted on suc
acts Thus, the risk exists tYou a?e
bj
anent disadvantages ou do not possess.
have served as su
assumptions to their app ou have a power that Y onsibility for any G7~~
may come to believe that Y ou assume rasp ~
owers or capabilities.
onal p
isk
a
aty
u
ou
pers
advised of this r
~ kabo
e
tyo r assumptions which Y
i~~~
s
.
osed by volunteer and answer
estions p
Qu
g? NOTE: Volunteer will initial end of each of above
paragraphs.
,~
RELEASABLE TO FOREIGN NATIONALS
Approved For Release 20~~~/03/07 : CIA-RDP96-007898002100150053-5