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Approved For Release 2000/08/08 : CIA-RDP96-00789R000100260001-2 SURVEILLANCE CONSENT AUTHORIZATION I, ,» voluntarily consent to perform duties as a beacon person for project remote viewing sessions. I understand that as a beacon person, I will serve as a focus for remote viewers. In agreeing to this duty, I acknowledge that: a. My thoughts relevant to the target sites that I am visiting may be accessed by a remote viewer. b. My thoughts that are not relevant to the target sites (e.g.; personal memories) may inadvertantly be accessed by a remote viewer. Should this occur, such data will be held in strictest confidence and will not be made part of any formal project records. I have also been appraised of the following: a. This consent can be withdrawn at any time without question or penalty. b. This consent will not be construed as authorization to conduct any form of surveillance without my prior knowledge or consent. This statement of authorization is executed in the presence of the witness on this day of » 19 » without reservation, amendment or restriction and without coercion or implied and/or stated inducements.//END// (SIGNATURE) (DATE) (WITNESS) (DATE) Approved For Release 2000/08/08 : CIA-RDP96-00789R000100260001-2