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The Moth Poetry Prize Entry Form 2024 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) □ Cash or postal order (Ireland/UK only) (€15 per poem) □ Final issue of The Moth (Ireland/UK) €7 □ Final issue of The Moth (Europe) €8 □ Final issue of The Moth (ROW) €10 □ Back issue of The Moth (Ireland/UK) €5 □
Gift bundle of 5 back issues (Ireland/UK) €20 □ Gift bundle of 5 back issues (Europe) €28 □ Gift bundle of 5 back issues (ROW) €32 □ Total ............................... The Moth Ardan Grange Milltown Belturbet Co. Cavan Ireland
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