My recipe:
Folded 8.5 x 5.5 Very Vanilla and used corner rounder on bottom corners.
Used Sage Shadow and stamped on folded card.
Stamped same image on Stamp-A-Ma-Jig with Stazon Black.
Cut Sage Shadow and Very Vanilla 1/4" smaller.
Used SAMJ to line up stamp and paper. This was the tricky part.
Stamped Medallion from stamp set and punched out with scallop punch. Poked with pin holes in scalloped edge.
Made large-ish whole with pin to push folded ribbon through hole and make knot leaving ribbon ends and cutting on angle behind medallion.
Stick on with Stampin Dimensionals.