[refresh]
   .=-----------=.
   | data | data | [X]  <-- checkboxes
   |=-----+------| 
   | data | data | [X]
   |=-----+-----=| 
   | data | data | [X]
   '=-----------='

##</code><code>##

<form name="myform" action="not_a_cgi.pl" method="get">
<input name="checkme" type="checkbox"/></form>