This is a card I did for a swap and am doing for my Hostess Club this weekend. It's a form of a donut card, the bottom left sucker is adhered on the inside with a dimensional and pokes through to the front of the card. I used a Horizontal Slot punch under where the other 2 circles are to thread the ribbon through.
The layout for this was inspired by a card on JulieHRR's blog: