The Moth Art Prize Entry Form 2018
 
 
Name:                   ....................................................................................................
 
Address:               ....................................................................................................
 
Email:                    ....................................................................................................
 
Tel:                        ....................................................................................................
 
Number of pieces: ....................................................................................................
(max of 10 per entry)

Where did you hear about the prize?:  ....................................................................
 
 
Purchasing: 
Entry to Moth Art Prize 20   □
Annual subscription to The Moth 28   □
Current issue of The Moth 7   □

Method of payment:
Cheque or cash   □
Money or postal order   □
Credit or debit card via PayPal (payment to mothartprize@themothmagazine.com)   □
PayPal transaction ID: 
 
Total ............................... 


 
Please read the rules before sending your portfolio to mothartprize@themothmagazine.com or:
 
The Moth Art Prize
The Moth
Ardan Grange
Milltown
Belturbet
Co. Cavan
Ireland H14 K768