The Moth Short Story Prize Entry Form 2023
 
 
 
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 | 15 per story   
Postal order (Ireland only) | 15 per story   
Credit or debit card via PayPal (payment to enquiries@themothmagazine.com) | 15 per story   
Final issue of The Moth | 7 (Ireland/UK)   □ 8 (Europe)  10 (ROW)  
Back issue of The Moth | 5  
Gift bundle The Moth (5 back issues) | 20 (IRL/UK)   
Gift bundle The Moth (5 back issues) | 28 (Europe)   
Gift bundle The Moth (5 back issues) | 32 (ROW)   
Digital issue of The Moth | 4   

 
Total ............................... 


 
Please read the rules before sending your story to:
 
The Moth Short Story Prize 2023
Ardan Grange
Milltown
Belturbet
Co. Cavan
Ireland H14 K768