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The Moth Poetry Prize Entry Form 2017/18
 
 
 
Name:                    ....................................................................................................
 
Address:                 ....................................................................................................
 
Email:                     ....................................................................................................
 
Tel:                       ....................................................................................................
 
Number of poems:    ....................................................................................................
 
Names of poems:   ....................................................................................................
                            
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Please do not include these details on the pages with the poems. 
 
 
Method of payment:
 
Cheque or cash (12 per poem)   
Money or postal order (12 per poem)   
Credit or debit card via PayPal (payment to enquiries@themothmagazine.com) (12 per poem)   
Annual subscription to The Moth 28   
Current issue of The Moth 7   
 
Total ............................... 


 
Please read the rules before sending your poem(s) to:
 
The Moth 
Ardan Grange
Milltown
Belturbet
Co. Cavan
Ireland