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The Moth Short Story Prize Entry Form 2021
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) □
Money or postal order (15 per story) □
Annual subscription to The Moth 28 (IRL/UK) □
Annual subscription to The Moth 32 (ROW) □
Current issue of The Moth 7 □
Digital issue of The Moth 6 □
Back issue of The Moth 5 □
Total ...............................
Please read the rules before sending your story to:
The Moth Short Story Prize 2021
Ardan Grange Milltown Belturbet
Co. Cavan
Ireland H14 K768
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