This card may look difficult, but if you look closely you will see that it is simply mulitiple layers.
The while textured layer is paintable textured wallpaper. Gift wrap was used for the metallic golds. One layer was cut with a decorative scissors.
One thing I like about this type of card is the mutliple uses. I could stamp something across the bottom for a specific occasion or leave it plain and put a note on the inside.
Rather than the punched medallion in the center, you could pick a stamped medallion or use a variety of stamped of textured squares or rectangles to create your beginning medallion. There are endless possiblities here.