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The Moth Short Story Prize Entry Form 2017
 
 
 
Name:                    ....................................................................................................
 
Address:                 ...................................................................................................
 
Email:                     ...................................................................................................
 
Tel:                       .....................................................................................................
 
Number of stories:    ................................................................................................
 
Names of stories:   ..................................................................................................
                            
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How did you hear about the prize:   ........................................................................

 
Please do not include these details on the pages with the stories. 
 
 
Method of payment:
 
Cheque or cash (12 per story)   
Money or postal order (12 per story)   
Credit or debit card via PayPal (payment to enquiries@themothmagazine.com) 12 per story   
Annual subscription to The Moth 24   
Current issue of The Moth 6   
 
Total ............................... 


 
Please read the rules before sending your story to:
 
The Moth Short Story Prize 2016
Ardan Grange
Milltown
Belturbet
Co. Cavan
Ireland