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The Moth Poetry Prize Entry Form 2021 Name: .................................................................................................... Address: .................................................................................................... Email: .................................................................................................... Tel: .................................................................................................... Number of poems: .................................................................................................... Names of poems: .................................................................................................... .................................................................................................... .................................................................................................... .................................................................................................... .................................................................................................... .................................................................................................... Please do not include these details on the pages with the poems. Method of payment: Cheque or cash (15 per poem) □ Money or postal order (15 per poem) □ Annual subscription to The Moth (Ireland/UK) 28 □ Annual subscription to The Moth (rest of world) 32 □
Current issue of The Moth 7 □
Back issue of The Moth 5 □
Total ...............................
Please read the rules before sending your poem(s) to: The Moth Ardan Grange Milltown Belturbet Co. Cavan Ireland
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