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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 □
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
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