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The Moth Art Prize Entry Form 2019 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 (ROW) □ Current issue of The Moth €7 □
Cheque or cash □ Money or postal order □ 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
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