my $city_list= $self->_getBuilderList;

# ...

my $template= $self->load_tmpl( ... );
$template->param(
  cities => $city_list,
  # ...
);

require HTML::FillInForm;
return HTML::FillInForm->new->fill(
  scalarref  => \$template->output,
  fobject    => $self->query,
);