<form id="ps-my-groups-form" name="ps-my-groups-form" action="member_privacy.php" method="post" enctype="multipart/form-data">
    <div class="ps-groups bx-def-bc-margin">
        <bx_repeat:groups>            
            <div class="ps-cell-chb">
                <input type="checkbox" name="ps-my-groups-ids[]" value="__group_id__" />
            </div>
            <div class="ps-cell-title">__group_title__(__group_members__)<bx_if:extended>__group_extended__</bx_if:extended></div>
            <div class="ps-cell-action">
                <a href="javascript:void(0)" onclick="javascript:ps_showDialog('add', __group_id__, this)"><img src="__add_img_url__" alt="__add_img_title__" title="__add_img_title__" /></a>&nbsp;
                <a href="javascript:void(0)" onclick="javascript:ps_showDialog('del', __group_id__, this)"><img src="__delete_img_url__" alt="__delete_img_title__" title="__delete_img_title__" /></a>
            </div>
        </bx_repeat:groups>
        <div class="clear_both">&nbsp;</div>
    </div>
    __control__
</form>