Digging through my stamps and dies, I found something that I thought would work. Here's my card.
Cardstock: SU Going Gray, PTI Soft Stone and Stamper's Select White
Ink: VersaMark, PTI Hibiscus Burst, Smokey Shadow, Summer Sunrise and SU Ruby Red Marker
Stamps: Paper Smooches I Heart Art and PTI Polka Dot Basics II
Dies: PTI Monthly Moments Spiral Notebook
Other: Foam Tape and Glossy Accents