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The Moth Poetry Prize Entry Form 2022 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 (Europe) 32 □ Annual subscription to The Moth (ROW) 40 □
Current issue of The Moth (Ireland/UK) 7 □ Current issue of The Moth (Europe) 8 □ Current issue of The Moth (ROW) 10 □ Back issue of The Moth 5 (Ireland/UK) □
Total ...............................
Please read the rules before sending your poem(s) to: The Moth Ardan Grange Milltown Belturbet Co. Cavan Ireland
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