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PRIZES MAGAZINE THEATRE

The Moth Poetry Prize Entry Form 2023
 
 
 
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)   □
Credit or debit card via PayPal (payment to enquiries@themothmagazine.com) (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 ............................... 

Please READ THE RULES before sending your poem(s) to:
 
The Moth 
Ardan Grange
Milltown
Belturbet
Co. Cavan
Ireland

 

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