I made this card quite recently for a friend. The Lettering is all cut out by hand and then mounted on foam pads. I've used the same teal spotty paper for the inside of the balloons to tie it all together. The sentiment was printed directly onto the card. I scanned in the Forever Friends bear onto the computer and then I've mirrored it and printed it off, so that I have them facing in different directions.I recently made a similar "Dad" version for Father's Day too.