<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 clearfix">
        <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 bx-def-padding-sec-leftright">__group_title__(__group_members__)<bx_if:extended>__group_extended__</bx_if:extended></div>
            <div class="ps-cell-action">
                <a class="bx-def-margin-sec-right" href="javascript:void(0)" onclick="javascript:ps_showDialog('add', __group_id__, this)" title="<bx_text_attribute:_ps_lcpt_add />"><i class="sys-icon plus"></i></a>
                <a href="javascript:void(0)" onclick="javascript:ps_showDialog('del', __group_id__, this)" title="<bx_text_attribute:_ps_lcpt_delete />"><i class="sys-icon minus"></i></a>
            </div>
        </bx_repeat:groups>
    </div>
    __control__
</form>