<div style="margin:5px">
	<p>{TXT_INTRO} {TXT_INSTRUCTION}</p>
	<!-- BEGIN item -->
	<!-- BEGIN cbox -->
	<input type="checkbox" name="{ITEM_NAME}" value="{ITEM_VALUE}"{ITEM_ADD} />
	<!-- END cbox -->
	{ITEM_TITLE}
	<!-- BEGIN item_info -->
	<span class="small"><em>({TXT_ITEM_INFO})</em></span>
	<!-- END item_info -->
	<br />
	<!-- END item -->
	<!-- BEGIN add_info -->
	<p>{TXT_ADDITIONAL_INFO}</p>
	<!-- END add_info -->
</div>