SURVEILLANCE CONSENT AUTHORIZATION (Sanitized)

CIA-STARGATE

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This document is a surveillance consent authorization form for the BEACON role in the CIA's Stargate program. The form states that the individual's consent is required for training and operational missions related to remote viewing. The authorization can be withdrawn verbally without penalty and it acknowledges the possibility of inadvertent surveillance of personal thoughts, which will be kept confidential. The individual explicitly states that the authorization does not include any form of surveillance without prior knowledge and consent. The form is executed with a witness present.

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Body:  ~*s
 A  roved For Release 20~9fOT':      -                             ~96-00789R002100150047-2
 pp
 SURVEILLA;vCE CO;~SENT  AL'THOYI7_A'I'ION
 SG1J
 WARNING NOTICE:       INTELLIGENCE SOURCES AND METHODS INVOLVED
 SG1J
 SGFOIA3
 training anal operational missions.  I understand that as a BEACON, I will serve as
 the focus f:or Remote Viewers.  In consenting to this statement I acknowledge that
 this authar.ization:
 da vo un arl y  consen            iZn duties as a BEACON (U Y for Project
 I                                       born on
 a.  Will only pertain to training and actual. SUN STREAK (U) missions and only
 with my prior consent and knowledge.
 b.  Can be entirely or selectively withdrawn without question or penalty.  To
 do so, I need only to orally inform my immediate supervisor, the unit operations
 officer or the project manager that I wish to withdraw my consent without further
 e.xplanat.i.on.
 c.  Will. suppose the possibility of inadvertent surveillance of my most intimate
 a.nd personal thoughts and that such inadvertent. surveillance will not be reported.
 nor become a matter of any official records and. that the nature of this inadvertently
 collected -information will. be held in strictest confidence.
 d.  Will at no time be construed as authorization, implied or stated, to conduct
 any type of physical, technical or yet to be defined form of surveillance without my
 prior knowledge and consent.
 This statement of authorization ~s executed in the presence of  he witness whose
 signature. appears on this   ~ r      day of           , 19 ~, without
 x-eservatian, amendment or restriction and witho t coercion or implied and/ar stated
 inducements.//END//
 Approved For Release 2001~~C1
 vdP12NINGNOTICE:  SENSITIVE
 ;NrELUGENCE SOURCES AND
 -00789 R002100"1~~`"1otvEo