Join the Active Project - Kelly Brush Foundation

Primary Role in the SCI Community*

Person with an SCI
Vendor/Program
Volunteer

First Name

Last Name

Program/Vendor Name

Internal Communications Email*

This is for admin & internal communications only. You'll have the opportunity to enter a public-facing email below.

Primary Contact First Name

Primary Contact Last Name

Image for Your Profile

Max. file size: 10 MB.

Choose an image you'd like representing you when people view your profile info.

Location of Your Placemarker*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Only City & State are required. (Vendor markers will be placed exactly at their addresses. Volunteers & people with SCIs will have their placemarkers lightly anonymized to conceal exact location).

Gender

Enter this as you'd like it displayed on your profile.

Injury

Date of Injury

Activity

Select all activities that you'd like shown on your profile (For people with SCIs: feel free to check any and all you're interested in, whether you already participate or would like to)

Description

Write a description of yourself or the program you represent, as you'd like it to appear on your profile.

Website

Email Address

This email address will be visible to members of the Active Project.

I would like these details displayed on my profile on the Active Project map:

Name
Picture
Personal description
Email
Social media handle
Approximate location (as entered above)

Social Link

Include a link to the social profile you'd like people to reach out to if they'd like to connect. Leave this blank if you aren't interested in sharing your contact information on the map.

Is there anything you'd like the KBF to know about your program?

This information will not be publicly displayed.

How did you hear about the Active Project?

Community

Fill out this form to be pre-registered for when the new Active Project goes live this summer.

Check out who has already pre-registered