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The Moth Art Prize Entry Form 2022 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 (IRL/UK) □ Annual subscription to The Moth €32 (Europe) □ Annual subscription to The Moth €40 (ROW) □ Annual subscription to The Moth (digital) €24 □ Current issue of The Moth €7 (IRL/UK) □ Current issue of The Moth €8 (EUROPE) □ Current issue of The Moth €10 (ROW) □ 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 |