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Moth Retreat Application Form
 
 
 
Name               ............................................................................................................................................................
 
Address            ...........................................................................................................................................................                

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Email               ............................................................................................................................................................
 
Phone              ............................................................................................................................................................
 
Biography        ...........................................................................................................................................................                

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Reference        ............................................................................................................................................................
 
How did you hear about the Moth Retreat?                                              

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When would you like to stay?             

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Minimum stay 1 week, maximum 2 weeks (€400 p.w, including non-refundable €50 p.w. per person deposit on booking). There is a supplementary fee of €100 per week if you bring a partner or friend (at The Moth’s discretion). The remaining balance of your payment should be made upon arrival at The Moth.
 
We aim to accommodate a range of artists and writers, and places are limited, so please don’t be disappointed if your application is unsuccessful.
 
Please return completed application form to willgovan@themothmagazine.com.

 

 

 

 

 

 

 

 

 

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