3rd Annual Kentucky Congress on Spinal Cord Injury
                                                                          June 18th, 2015
                                              Griffin Gate Marriott Resort and Spa, Lexington, KY

The mission of the Kentucky Congress on Spinal Cord Injury (KCSCI) is to gather individuals with SCI from around the commonwealth to join in the discussion of critical issues that are important to them and to help draft agendas to be used to legislate changes in our commonwealth for people with SCI.
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Have you had a spinal cord injury
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